ࡱ> a ibjbj AM\M\9b b 8& D&j!!!!k"*#1$P DDDDDDD$FzI3D&k"k"&&3D!!D777&F!! D7& D77R=@A!`Ա >' 1ACD0DOAB K^) K<A KAh$Z$@7%4O%$$$3D3Dn/D$$$D&&&& K$$$$$$$$$b > : Wisconsin Department of Public Instruction MASTER EDUCATOR ASSESSMENT PROCESS (WMEAP) EMPLOYMENT VERIFICATION(S) PI-WMEAP-0003 (Rev. 10-16) INSTRUCTIONS: To Present or Former EmployerComplete and return at your earliest opportunity to the Wisconsin Master Educator Assessment Process Assessor Nominee listed in Section I. He or she must submit this verification with his/her nomination materials to: WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION ATTN: CHARLENE KOCI TEACHER EDUCATION, PROFESSIONAL DEVELOPMENT AND LICENSING TEAM PO BOX 7841 MADISON, WI 53707-7841Collection of this information is a requirement of PI 34.19(4). *Educator entity numbers can be found on the DPI Educator License Lookup at  HYPERLINK "http://dpi.wi.gov/tepdl/license-lookup" http://dpi.wi.gov/tepdl/license-lookupI. ASSESSOR INFORMATION Nominee completes this section and forwards to administrator.Legal Name Last, First, Initial  FORMTEXT      DPI Educator Entity Number*  FORMTEXT      Date of Birth Mo./Day/Yr.  FORMTEXT      Name of Employing School/District  FORMTEXT      Position Held  FORMTEXT      Location of Employment  FORMTEXT      Employment DatesFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      II. VERIFICATION BY EMPLOYERTo the Employer: Check your records to verify that the above applicant has been or is successfully employed in your district in one of the following official capacities. Check the specific field based on the applicants contract(s), list dates (month/year to month/year) and FTE (full time equivalency).ADMINISTRATIONTEACHINGPUPIL SERVICES FORMCHECKBOX  Director of Instruction FORMCHECKBOX  Adaptive Education FORMCHECKBOX  School CounselorFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT       FORMCHECKBOX  Director of Special Educ & Pupil Services FORMCHECKBOX  Adaptive Physical Education FORMCHECKBOX  School NurseFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT       FORMCHECKBOX  Instructional Library Media Supervisor FORMCHECKBOX  Assistive Technology FORMCHECKBOX  School PsychologistFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT       FORMCHECKBOX  Instructional Technology Coordinator FORMCHECKBOX  Speech and Language Pathology FORMCHECKBOX  School Social WorkerFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo-s     5 7 v w ! 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FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT       FORMCHECKBOX  Principal FORMCHECKBOX  Computer ScienceFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT       FORMCHECKBOX  Reading Specialist FORMCHECKBOX  DanceFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT       FORMCHECKBOX  School Business Administrator FORMCHECKBOX  PsychologyFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT       FORMCHECKBOX  School District Admin. or Superintendent FORMCHECKBOX  TheatreFrom Mo./Yr.  FORMTEXT      To Mo./Yr.  FORMTEXT      FTE  FORMTEXT      From Mo./Yr.  FORMTEXT      To Mo./Yr.  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