_________________________________________________________________________

1	* Please enter your full name:

2	* School(s) assigned to:

3	* What is the primary program you are associated with: Pre-School Resource Room Extended Resource Room Positive Behavior Interventions Opportunity School Occupational Therapy Speech Language Pathology Interpreter Community Transition IBI Achievement House

4	* When you are hired to work in a special education program, you must agree that you are able to meet four provisions. Which of the following is not one of these provisions. Your assignment is based on student load and/or individual student; You may be required to lift, restrain and/or diaper students; You may be required to perform health-related services with training and supervision; You may be required to create educational programming for your students.