West Virginia Department of Education
Special Education Technology Integration Specialist (SE-TIS) Application
Directions: Type responses into the form, print and mail it with assurance agreements to: WVDE, 1900
Kanawha Blvd. East, Building 6, Room 304, Charleston, WV 25305 Attention: Valerie Wilson
Or scan and email to vwilson@k12.wv.us. Due April 25, 2016.
Name
Email
Current Teaching Position
Home Phone
Mobile
Address
County/District
School
School Address
School Phone
Principal
Principal’s email
Years of Teaching Experience
Do you have Internet access at home?
Are you willing to participate in a monthly online professional learning community?
List your certifications and/or endorsements
List resources that you currently use when integrating technology into your curriculum.
Describe how your deeper knowledge of technology integration acquired from the SE-TIS program will
increase student achievement of all students in your classroom or school.
1
How will your interaction with other staff at your school change as a result of participation in the SE-TIS
program?
2