Arkansas Department of Education

Arkansas Qualified Teacher Designation Form (MULTI-SUBJECT, for Secondary grades)

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(s). The Multi-Subject HOUSSE form (to designate content knowledge) may ONLY be used by teachers in Alternative Learning Environments or Special Education, who teach two or more subjects and seek Arkansas Qualified Teacher status as a Multi-Subject AQT.

Teacher Name ____ Date ____

School ____ School District ____

Choose level of AQT status being sought. Choose the content areas.

☐ Secondary/Grades 7-12

☐ English

☐ Reading or Language Arts

☐ Mathematics

☐ Science: (Specify subject _______)

☐ Art

Indicate Instructional Class

☐ Alternative Learning Environment

☐ Special Education

☐ 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? (Provide the appropriate information and documentation.)

☐ I am an Alternative Learning Environment teacher and I have accumulated >100 points in each of the designated areas on the Secondary-grades Multi-Subject ARHOUSSE criteria survey.

☐ I am a Special Education teacher and I have accumulated >100 points in each of the designated areas on the Secondary-grades Multi-Subject ARHOUSSE criteria survey.

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. IN CONJUNCTION WITH YOUR SCHOOL/DISTRICT ADMINISTRATOR YOU ARE TO DEVELOP, MAINTAIN AND ADHERE TO A WRITTEN PLAN FOR BECOMING AN ARKANSAS QUALIFIED TEACHER IN THESE AREAS BY THE END OF THIS SCHOOL YEAR.

Teacher's signature

Date

School or District Administrator's name

School or 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.

Multi-Subject Arkansas High Objective Uniform State Standard of Evaluation (MS-ARHOUSSE)

for Secondary grades

To establish Arkansas Qualified Teacher status as a Multi-Subject teacher a teacher must be teaching in one of the Instructional Classes listed below, and be teaching two or more of the content areas listed below. To demonstrate content knowledge via Multi-Subject ARHOUSSE a minimum of 100 points is required per content area taught.

Teacher Name ____ Date ____

School ____ School District ____

Indicate level of AQT status being sought. ☐ Secondary/Grades 7-12	Indicate the content areas to be considered for this AQT designation. ☐ English ☐ Reading / Language Arts ☐ Math ☐ Science: (subject _______)
Indicate Instructional Class ☐ Alternative Learning Environment ☐ Special Education	☐ Art ☐ Social Studies: (subject _______)
	☐ Music ☐ Foreign Language: (subject _______)

NOTE: CONTENT KNOWLEDGE ONLY USE MULTIPLE SHEETS AS NECESSARY

Subject (from page 1) _______

The following evidence must be in the content area indicated above.

	Points
Praxis II Middle School: Content Knowledge test (#0146), Praxis II: Middle School Multiple Subjects (#5141), or other appropriate state-mandated content-area assessment if the subject area above is Math, Science, English or Social Studies	25 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.) CLEP Exams in content area	50 points
NBPTS Certification in this content area	100 pts
Content test in this area 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, if used, 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) or Education Service Co-operatives 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 on line or teleconferences, webcast professional development, CIV workshops, project based authentic learning lessons developed 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 or Subject Area Mentor Participant, Peer review of content specific experience in this content area. _______	# yrs served 10 pts per year (30 pts max)
Participation in a content-specific Arkansas Leadership Academy Individual or Team Institute, or other content specific experience training, etc. _______	20 pts per academy
Participation in SIM, etc. Curriculum Training – Year Long	20 pts per year
Participation in Arkansas Mathematics and Science Professional Development Institute – Year Long, Participation in Core Content Competency Based Assessment Circles, Formative Assessment Training and application throughout the year in content area, etc. _______	20 pts per year
Participation in Effective Literacy, Literacy Lab, Reading First, IDEAs Portal, Web Quest, Teacher-2-Teacher Initiatives, Academic Academies, or similar curriculum training – Year Long (Describe.) _______	1 point per hour up to 20 points per year
Total

_______ Teacher's signature

_______ Date

_______ School District Administrator's name

_______ Date

_______ 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.