ECSEL Supplemental Application

The following supplemental application will serve as the face page of your completed application packet. It provides contact information, summarizes important leadership experience, and certifies your participation in internships and seminars.

The complete list of application materials is available on the Application Information page. Applications will not be reviewed until all the application materials have been received.

Section 1: Applicant Information

Question 1.

First Name: Required

Question 2.

Middle Name:

Question 3.

Last Name: Required

Question 4.

Best Contact Email:Required

Section 2: applicant experience

Question 5.

Public School Employment-Current School (if applicable): Required

Question 6.

Current District: Required

Question 7.

ESD (Educational Service District): Required

Question 8.

Number of Years of Professional Experience in Schools (as a Teacher or Related Services Professional: Required

Question 9.

Number of Years Experience as a Special Education teacher: Required

Question 10.

Indicate all levels taught: Required

Elementary
Middle Level
Secondary

Question 10.

Please list all specialist teaching or related services certifications and endorsements:

Special Education Leadership Experience

Use the following boxes to describe up to four recent significant leadership responsibilities in special education. Be prepared to include the number of years within the position, number of hours worked per week in that role, and to describe the role and your accomplishments within it.

Question 12.

Recent Experience #1:

Please include the following information:Title/Role

Title/Role
Years in this position
Number of Hours per week in this position
Description of responsibilities and accomplishments within the role.

Required

Question 13.

Recent Experience #2:

Please include the following information:Title/Role

Title/Role
Years in this position
Number of Hours per week in this position
Description of responsibilities and accomplishments within the role.

Question 14.

Recent Experience #3:

Please include the following information:Title/Role

Title/Role
Years in this position
Number of Hours per week in this position
Description of responsibilities and accomplishments within the role.

Question 15.

Recent Experience #4:

Please include the following information:Title/Role

Title/Role
Years in this position
Number of Hours per week in this position
Description of responsibilities and accomplishments within the role.

Additional Leadership Experience

Question 16.

Please describe any leadership experience you've had outside of education.:

Please include the following information:Title/Role

Title/Role
Years in this position
Number of Hours per week in this position
Description of responsibilities and accomplishments within the role.

Required

Section 3: Assurance and Documentation of Full Program Participation

The following section asks questions related to internship commitments required for completion of the ECSEL program.

Question 17.

Internship Year 1: The first year of ECSEL requires a 400-hour internship at the school level. Each candidate works closely with a school-level mentor to complete course performance tasks as related to the needs of the school and role of the candidate. Examples of Year 1 internship activities vary per candidate/school but could include: Organizing data to inform a new dropout prevention program in the school, leading the implementation of a school-wide PBIS program, learning the role of the principal in organizing support for students who are not at standard

Please describe how your current position will support completion of the school-level special education leadership internship requirement:

Question 18.

Internship Year 2: The second year of ECSEL requires a 400-hour internship at the district level. Each candidate works closely with a district-level mentor to complete course performance tasks as related to the needs of the district. Examples of Year 2 internship activities vary per candidate/district but could include: Assuming responsibility for district special education grant applications, collaborating with basic education in designing systems to meet the needs of struggling learners, developing and leading a process or plan to solve a departmental problem.

Please describe how your current position would allow completion of the district-level special education leadership internship requirement.:

Question 19.

Please provide assurance that you will be able to attend all scheduled weekend and retreat sessions of the ECSEL program. These will be held in the Seattle metropolitan area (currently, the University of Washington - Bothell campus), with candidates responsible for their own transportation (and lodging, if needed). Seminar dates are located on the website:

http://www.bothell.washington.edu/education/ecsel
If you agree to the above schedule, please check “I Agree”: Required

I Agree

Question 20.

If you are unable to attend all of the proposed seminar dates, please list dates you are unable to attend:

Security Question Security Question: Required