Continuing Education Units You must sign up for CEUs BEFORE a course begins. See enclosed instructions. 12729 Northup Way Suite 1 Bellevue, WA 98005 Slingerland Course Application 2014 Sessions Course fee includes materials* unless indicated (425) 453-1190 Class location: June 5 July 2 (Intro only) Valley Christian School, San Jose CA Price: $2600 June 12 July 11 Hope Academy, Concord, CA Price: $2600 This sites requires prior approval of applicants PERSONAL INFORMATION: *TBA Assets School, Honolulu, HI Price: $2600 *June 26 July 25 San Francisco, CA Price: $TBA *June 23-July 18 Prentice School, Santa Ana, CA Price: $2600 *July 2-August 1 Hamlin Robinson School, Seattle, WA Price: $2700 TBA Bias Mikroh, Monsey NY Price: $2600 July 8 August 1 (Continuum only) Valley Christian School, San Jose, CA Price: $2600 July 7 August 1 Wise Choice Educational Solutions, Portland, OR Price: $2600 TBA - July Austen-Coley Academy, Longview, TX Price: $2600 Other: Name Address City Zip Email Phone DEMOGRAPHICS: Gender Male Female Do Not Wish to Provide *Ethnicity (choose all that apply) *The Institute is required to collect this information for tax purposes White/European American Black/African American Hispanic/ Latin American Asian Pacific Islander American Indian/Alaska Native Middle Eastern No Response BACKGROUND: Highest level of education achieved: Credential(s) held Current position Work Site Address: Number of years teaching experience (if applicable): Positions held Please list prior Slingerland Training courses: Course Location year Course Location year Course Location year List other multisensory structured language courses taken Are you using the Slingerland Approach now? How many minutes daily? Please indicate the course you are registering for: First Year Introductory* Second Year Continuum (prerequisite: 1 st yr) Third Year (prerequisite: 1 st & 2 nd yrs) MATERIALS: Additional fees may apply to the sites with the * Please indicate materials package preference? Manuscript Cursive *Return this completed form with your $250 deposit or Purchase Order Form payable to the Slingerland Institute for Literacy as soon as possible. Tuition must be paid in full by the first day of class. A payment plan is available. Please contact the Slingerland office if you would like an application. The paperwork must be submitted and approved at least two weeks before the beginning of the course. You will be notified of your acceptance/plan approval as soon as possible. Once notified of acceptance, deposit is non refundable. Questions? Call (425) 453 1190 or email mail@slingerland.org send faxes to (425) 635 7762 12729 Northup Way, Suite 1, Bellevue WA 98005 *= The above deposit availability does not apply to these sites; please contact these sites directly using the online email link. Non-discrimination Policy: Slingerland Institute for Literacy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and T:\FORMS\Summer activities generally Session\SS accorded 14 or Teacher made available application.doc to students. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and other programs.
SLINGERLAND I NSTITUTE FOR L ITERACY Improving educational opportunities for all learners, especially those with dyslexia RE: Criminal History/Background Check It is the policy of Slingerland Institute to perform criminal history and background checks on all staff, directors/instructors, participants, and volunteers of a Slingerland Comprehensive Course. The policy specifically applies to the Slingerland comprehensive courses involving participation with children. Please find enclosed an Application for Criminal History/Background Report that must be completed and returned to the Slingerland Institute administrative offices as soon as possible. The form must be returned prior to commencement of the course. Note that your official enrollment is dependent upon completion and return of this form. Conviction information may not necessarily disqualify a person from participating in a course or being contracted by the Slingerland Institute. A copy of the Slingerland Institute s Criminal History Policy is also attached for your review. All information obtained by the Institute will be kept in the strictest confidence and used for the above-mentioned purposes only. Thank you for your prompt attention to this matter. Sincerely, Slingerland Institute for Literacy Enclosures 1) Slingerland Institute Criminal History Policy 2) Application for Criminal History/Background Report 12729 NORTHUP WAY, SUITE 1 BELLEVUE, WA 98005 T 425-453-1190 F 425-635-7762 WWW.SLINGERLAND.ORG MAIL@SLINGERLAND.ORG
12729 Northup Way Suite 1 Bellevue, WA 98005 Phone: 425-453-1190 Fax: 425-635-7762 E-mail: mail@slingerland.org APPLICATION FOR CRIMINAL HISTORY/BACKGROUND REPORT Please fill out the application completely. Print legibly Read the Criminal Records Information Waiver below Sign and Return the completed form to: Slingerland Institute for Literacy 12729 Northup Way, Suite 1 Bellevue, WA 98005 Last Name: First Name: Date of Birth: / / SSN: month day year Driver License Number: State of Issue: Marital Status: S / M / D If divorced: Date of dissolution: Did it result in a name change: Yes No Prior Name: Current Address: How long: City: State: Zip: If less than five years at the current address, please list any previous addresses: Prior Address: How long: City: State: Zip: Prior Address: How long: City: State: Zip: CRIMINAL RECORDS INFORMATION WAIVER As an applicant for employment by the Slingerland Institute for Literacy or an independent contractor, a participant or volunteer in a Slingerland Comprehensive Teacher Training course, I hereby authorize Slingerland Institute to conduct a criminal history, background and abuse registry search. This search will include criminal records with any state or federal legal entities that have such records. I certify that the information I have given on this form is true and correct to the best of my knowledge. Applicant Signature: Date: For Slingerland Office Use Only Date Appl. Received: Date CH/BCK Records Check Performed: Check Performed by (initials): Approved by: Course Location:
C RIMINAL H ISTOR Y P OL ICY Purpose In furtherance of its goal of protecting the welfare of human and financial resources, the Slingerland Institute for Literacy shall inquire into the criminal history background of any individual who 1. is employed; 2. serves as an independent contractor; 3. is a course participant who comes in contact with children; or 4. is a volunteer who comes in contact with children. This process will be conducted in a manner that balances the Institute s interest in protecting the general welfare and in respecting individual privacy. Policy All employees, independent contractors, course participants, or volunteers as identified above will be asked to voluntarily disclose any criminal disposition and to consent to a criminal background check by signing a criminal history authorization form. This process is intended to assess an individual s suitability for a specific position, in light of specific prior criminal convictions, which raise a reasonable concern as to the Institute s potential to incur possible financial or property loss, safety risk, or other harm arising from the individual s association with the organization. A prior conviction does not necessarily make an individual ineligible for employment, contract or participation. The criminal history will be evaluated for relevance, if any, to the specific position responsibilities. The evaluation shall consider, but shall not necessarily be limited to, the following factors: Falsification of application pertaining to the conviction(s) Date of conviction(s) Subsequent employment record Number and gravity of crimes committed and the nature of the crime(s) in relationship to the nature of the work to be performed Potential opportunity, through possible abuse of work-related functions or situations to cause financial, property loss, safety risk or other harm. Procedures The Business Manager, in consultation with the Executive Director, will conduct the background check and will be responsible for retention and destruction of criminal history information. Personal information will be kept in a locked and secured location. The criminal history check will be conducted using tools such as, but not limited to, national background check services for a fee and/or internet criminal history search engines. Background checks will be completed before first date of employment, service, or training course. Individuals will be informed of the information in the report, in writing if possible, before the report is discussed with the program director and be given a reasonable time to provide documentation establishing that the report is inaccurate, in error, expunged, or otherwise unreliable. All criminal background checks and information will be kept strictly confidential. The Slingerland Institute will follow all state and federal guidelines for obtaining the criminal background information, including providing copies, if required, of the criminal background report to applicant. The Slingerland Institute for Literacy reserves the right to make exceptions modify or eliminate this policy. CRIMINAL HISTORY POLICY Adopted 3/09/09 FILENAME \p T:\Admin Documents\Policies\Criminal History Policy.doc
Course participants SLINGERLAND Phone (425) 453-1190 INSTITUTE FOR LITERACY Fax (425) 635-7762 12729 Northup Way, Suite 1 Bellevue, WA 98005 Email: mail@slingerland.org INSTRUCTIONS FOR USD Continuing Education Units 1. The Slingerland Institute s Comprehensive Training and Short Courses are approved for units of graduate level extension credit by the Continuing Education Department of the University of San Diego (USD). The course credits through University of San Diego are continuing education units only and NOT part of a degree program. Credits may or may not transfer into a degree program any transfers will be at the discretion of the institution providing the master s degree. The credits are at the option of the participants and must be applied for BEFORE the first day of the Slingerland training course. USD will not allow course enrollment after the first day of the course. 2. USD continuing education credits are applied for through the University of San Diego s online enrollment page. USD charges $75 per unit / $37.50 per half unit. 3. Prior to the beginning of the course, the Institute will provide the following information for completing the online enrollment. Name of the course Course number Course dates Number of units assigned to the Course Cost for the units Direct link to the online enrollment page for all courses in that category 4. To Enroll in a course: Go to: pce.sandiego.edu Select the Find a Program tab at the top of the page At the dropdown, choose Affiliations Choose Slingerland from the list. The system will bring up the SIL Affiliate page with the current list of SIL courses. Choose the course you want. The system will bring up the course description for that course plus options to Email, Remind or Notify information about the course. NOTE There may be several sessions of the same course listed. Please make sure you choose the course with the correct date, otherwise you may not be approved and will not receive the continuing education units. Below the course description is the option to Add to Cart. When the participant clicks Add to Cart the system will take them to the Checkout Page where they can Continue to Check out or Keep Shopping. Note this page also lists the T:\FORMS\USD Credit Instructions for Participants-2013.doc USD CREDIT INSTRUCTIONS FOR PARTICIPANTS Page 1 of 2
instructions to Pay by Other Methods (check, PO, money order, etc.) If they choose Continue to Checkout, they will be taken to the student portal page where they can sign into their account or create a new account. All students must have a student account. Follow the online instructions to complete the registration process and pay for the credits. 5. If you must pay for your enrollment via check, checks are to be payable to: University of San Diego or USD. Please follow the online instructions and send in your payment as soon as possible. Enrollment for continuing education units is not complete until USD has received the payment. 6. The Institute will prepare the attendance and grade sheets for signature by the course Director. 7. The Institute will input the grade information into USD s online system within one week after receipt of the attendance and grade sheets. 8. Participants will receive an official transcript reflecting the assigned units of credit directly from USD by mail. Normal processing time is three to four weeks after input of the grades. 9. We will be glad to answer any questions at the office 425 453 1190 or email us at mail@slingerland.org. Thank you Slingerland Institute T:\FORMS\USD Credit Instructions for Participants-2013.doc USD CREDIT INSTRUCTIONS FOR PARTICIPANTS Page 2 of 2