  Application Form 2016-2017  
Polk County School Board
ACE Professional Development Certification Program
IMPORTANT: Prior to completing the application below, it is necessary for the applicant to review all requirements of this application in regards to the Professional Development Certification Program to become familiar with participation in this program. To acquire more information, please call the Polk County School’s office of Professional Learning at 647-4280 [57310] and ask to speak with the ACE Coordinator.
The application below is to request participation in the Polk County Schools ACE Professional Development Certification Program. In accordance with Florida statutes, the ACE Program is designed to provide mid-career professionals or recent non-college of education graduates the opportunity to fulfill instructional requirements to qualify as an educator. After completing the ACE Program, the participant may seek a professional certificate. Please note that participation in the program does not guarantee certification and fees are nonrefundable, all requirements must be fulfilled to complete successfully.
Prerequisites:
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Must have a full-time, paid instructional position with Polk County School District in a position that does not vary from day to day. (Participants must be the teacher of record with students assigned to them as their teacher. ACE tasks do require direct student contact over time.)
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Successfully passed Subject Area Exam in subject taught.
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Successfully passed all subtests on the General Knowledge Exam.
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Hold a Temporary Teaching Certificate.
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Complete application with administrator's signature of approval.
The application below must be completed in entirety.
Applicant Information: Please type or print all information below. | Today’s Date: |
| Name: |
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SAP:
| Address: |
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City, State, Zip:
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Telephone:
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Birth date:
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Assigned School:
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School Board E-Mail:
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Undergraduate Degree:
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Level: BA BS
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Graduation Date
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Graduate Degree:
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| Graduation Date |
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School Telephone:
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Hire date:
Teaching start date:
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___________________________
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Teaching Assignment:
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Previous occupation:
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Temp. Teaching Certificate Area:
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Expiration date of Certificate:
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Subject Area Test Taken and Passed:
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Subject Area Test Date
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I have passed all subtests of the General Knowledge Exam
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Yes
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General Knowledge Test Date
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| ACE Program Nonrefundable* Fee: $1000 (Check or money order made out to Polk County School District).
Fees for District Charter School Teachers $1250
Check or money order must be included with application. Credit cards not accepted at this time. No payroll deduction or partial payments. |
*Please note that the application fee is nonrefundable. Please read and consider all requirements before making application.
Please send completed application to ACE Coordinator, Professional Development, Jim Miles PD Center, Route E.
Page 2: Name of Applicant |
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An administrator at the site school who signs this application is the administrator who agrees to serve on the support team for this applicant. This administrator agrees to:
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Sign the application as indication of approval.
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Conduct the teacher observation evaluation process.
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Assist the Professional Learning Department in decisions concerning the participant and completion of the ACE Program.
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Complete The ACE Program Satisfaction Survey.
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Meet any other requirement of the law.
Signature of Site Administrator ______________________________________________
Site Administrator Print_______________________________________________
Today’s Date ____________________________________________________________
*Please note that your signature is indication that you recommend the teacher as an excellent candidate for the ACE Program and agreement to fulfill the responsibilities outlined above. |
I agree, as a participant in the ACE Program to:
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Attend and participate in all days of initial TIPS Training and follow-up requirements.
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Attend ACE Orientation Session to learn about getting started on the program.
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Attend ACE face to face mentoring sessions for assistance as needed.
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Attend any ACE required meetings/trainings.
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Demonstrate accomplished practices through observations by an administrator.
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Complete the ACE Survey prior to beginning the program and at program completion.
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Successfully complete the Reading Competency 2 Course of the Reading Endorsement during first year of program.
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Provide copies of my Teacher Evaluation and Teacher Observations/Walk Throughs as requested.
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Comply with provided ACE deadlines for completion.
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Complete an ACE Digital Portfolio to be kept on file for five years in PD.
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Notify District Certification Department if ACE status changes. (Must be currently employed by the district as a full time teacher of record with students assigned to participate in ACE)
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Pass the Florida Professional Education Test. **Scores take 15-30 days to post to the DOE
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Apply to the state for your Professional Certificate.
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Meet any other requirement of law.
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Along with the Completed Program Application Please Submit:
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A copy of the Yearly Teacher Evaluation Stage 1 (if one was completed)
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A Check or Money order for $1000 ***fees are nonrefundable (Fees for District Charter School Teachers $1250)
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Cell Phone Number: Alternate email Address:
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I have read and understand the ACE Program Guidelines listed above. Please initial _______
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I understand the enrollment fees are nonrefundable. Please initial _______
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Signature of Applicant ___________________________________ Today’s Date _______
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Please send completed application to ACE Coordinator, Professional Development, Jim Miles PD Center, Route E.
Updated 8.18.16
Page of 2 ACE Application
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