6 CAR pt. 182, Appendix A
Arkansas Qualified Teacher Designation Form (SINGLE SUBJECT)
An Arkansas qualified teacher (AQT) must have at least a bachelor's degree; must be appropriately licensed to teach; and must demonstrate content knowledge in the subject area. This form may be used by any Arkansas teacher for whichever AQT status is being sought.
Teacher Name ____ Date ___ School ____ School District ___
Choose level of AQT status being sought.
☐ Early Childhood/Elementary-K-6
☐ Middle Childhood/Grades 4-8
☐ Secondary/Grades 7-12
If applicable choose the subject area.
☐ English
☐ Reading or Language Arts
☐ Mathematics
☐ Science: (Specify subject _______)
☐ Art
☐ Social Studies: (Specify subject _______)
☐ Music
☐ Foreign Language: (Specify language _______)
1) BACHELOR'S DEGREE (Provide the appropriate information and documentation.)
Degree ____ Date Awarded ____ Institution _______
2) ARKANSAS TEACHING LICENSE (Check one and provide the appropriate information.)
☐ INITIAL
☐ NTLP PROVISIONAL
☐ PROFESSIONAL TEACHING PERMIT OR PPTL
☐ STANDARD
☐ RECIPROCITY PROVISIONAL (all requirements completed except AR History course)
Area ____ Level ____ Expiration date: _______
3) DEMONSTRATION OF CONTENT KNOWLEDGE IN THE SUBJECT OR AREA? (Check A or B or C, and provide the appropriate information and documentation.)
3.A. ☐ I passed the Praxis Content Knowledge assessment, or licensure content test in other state.
Assessment _______
Passing Score _______
Date taken _______
OR
3.B. ☐ I am a Middle School or Secondary teacher and I have a major, or coursework equivalent to a major (24 credit hours), or graduate degree, or National Board Certification in the area. (Explain)
OR
3.C. ☐ I am a Veteran teacher and I have accumulated >100 points in this area on the ARHOUSSE criteria survey.
Score =
_______ (Attach a copy of the ARHOUSSE form.)
4) Are you AQT (i.e., do you have all of 1, 2, and 3 above)? Yes ____ No ____
If you do not meet all three criteria (1, 2, & 3 above) you cannot be designated as an Arkansas qualified teacher in this area at this time. As appropriate, and in conjunction with the school/district administrator the teacher is to develop, maintain and adhere to a written plan for becoming an Arkansas Qualified Teacher in this area by the end of this school year.
Teacher's signature _______
Date _______
School District Administrator's name _______
School District Administrator's signature _______
Date _______
TEACHERS ARE TO ATTACH ALL APPROPRIATE DOCUMENTATION. COPIES OF ALL ARE TO BE MAINTAINED BY THE TEACHER AND KEPT ON FILE IN THE SCHOOL DISTRICT.
To demonstrate subject area content knowledge a teacher must accumulate at least 100 points in the selected area. This may be done by any teacher for whichever AQT status is being sought.
Teacher Name ____ Date ___ School ____ School District ___
Choose level of AQT status being sought.
☐ Early Childhood/Elementary, K-6
☐ Middle Childhood, Grades 4-8
☐ Secondary, Grades 7-12
If applicable choose the content area.
☐ English
☐ Reading or Language Arts
☐ Mathematics
☐ Science: (Specify subject _______)
☐ Art
☐ Social Studies: (Specify subject _______)
☐ Music
☐ Foreign Language: (Specify language _______)
The following evidence must be in the content area indicated above.
Points
| National Teacher Exam Content Area Assessment(s) for this content area (e.g., Praxis # 010) or other non-Praxis non-licensure Content test (Describe) | 50 points | |
|---|---|---|
| NBPTS Certification for this content area (including Elementary) | 100 pts | |
| Content test taken for licensure in another state (describe) | 100 pts | |
| Years of teaching experience in this subject area within the last ten years (10 pts/year) | # of years ___ (50 pts max) | |
| Content-based Professional Development - according to the school's Prof. Dev. Plan (1 pt/hr up to 8 pts/year) | # of years ___ (40 pts max) |
The following must NOT HAVE BEEN USED ABOVE under Professional Development.
| College/University Coursework in the content area List coursework ____ ___ ____ ___ ____ ___ ____ ___ | # credit hours ___ 3 pts per credit hour | |
|---|---|---|
| Served in an administrative capacity in the content area, e.g., Dept. chair, ACSIP chair, Lead teacher, etc. Describe: _______ | # of years served 10 pts per year (30 pts max) | |
| Documented Committee service in local (LEA) curriculum development in this content area in the last five years Describe: _______ | # of activities ___ 5 pts per activity (25 pts max) | |
| Documented Committee service in state or national curriculum development in this content area in the last five years Describe: _______ | # of activities ___ 10 pts per activity (30 pts max) |
| Textbook adoption committee service in this content area over the last five years Describe: _ __ _____ | # of committees _____ 15 pts per committee (30 pts max) | |
|---|---|---|
| Papers published in refereed journals in this content area in the last five years Describe: _ __ _____ | # of papers _____ 10 pts per paper (30 pts max) | |
| Presentations made at content-area or specialty-area association conferences in the last five years Describe: _ __ _____ | # of pres'ns _____ 10 pts per pres'n (30 pts max) | |
| Conferences attended in this content area in the last five years Describe: _ __ _____ | # of conferences _____ 5 pts per conference (15 pts max) | |
| Service as a ADE Certified Mentor Mentor in this content area | # of years served _____ 10 pts per year (30 pts max) | |
| Participation in Arkansas Leadership Academy Individual or Team Institute | 20 pts per academy | |
| Participation in ELLA Curriculum Training – Year Long | 20 pts per year | |
| Participation in Arkansas Mathematics and Science Professional Development Institute – Year Long | 20 pts per year | |
| Participation in Effective Literacy, Literacy Lab, Reading First, Curriculum Training, or some similar activity – Year Long (describe) _____ | 1 point per hour up to 20 points per year | |
| Total |
Teacher's signature
Date
School District Administrator
School District Administrator's signature
Date
TEACHERS ARE TO ATTACH ALL APPROPRIATE DOCUMENTATION. COPIES OF ALL ARE TO BE MAINTAINED BY THE TEACHER AND KEPT ON FILE IN THE SCHOOL DISTRICT.