EVALUATORS PROFILE SHEET

EVALUATOR PROFILE FORM

* Required information

Commission Member Contact:*

Region:

Have you worked for a publishing company or piloted a program in the last five years? If so, in what capacity?

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First Name:*

Middle Initial:

Last Name:*

Home Address:*

City:*

State:*

Zip Code:*

Work Address:*

City:*

State:*

Zip Code:*

Name of School (Workplace):

Principal:

School System:

Superintendent:

I am a: 10-month employee 11-month employee 12-month employee

Home No. (xxx) xxx-xxxx:*

Work No. (xxx) xxx-xxxx:

Email (W):

Email (H):

Job Title:

Grade/Subject(s) Taught Within Last Two Years:

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Area(s) and Grade Level(s) To Evaluate:

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Is teaching experience within the last two years in North Carolina?

Yes No

Any other comments:

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