1) Personal Contact InformationLast NameFirst NameMiddle InitialHome AddressHome Address 2CityState/ProvinceZip CodeCountryHome PhoneFormat: (999) 999-9999Cell PhoneFormat: (999) 999-9999Home Email2) Employment Contact InformationBusiness/Institution NameDepartment Address 1Department Address 2CityState/ProvinceZip CodeCountryWork PhoneFormat: (999) 999-9999Work Email3) What is your native language?English Spanish Other (please specify) If you selected other, please specify:4) Which other languages do you read, write, and/or speak fluently? Please select all that apply.American English British English Chinese French German Haitian Creole Italian Korean Russian Spanish Other (please specify) If you selected other, please specify:5) Using the matrix below, indicate the degree and your major field of study. Please select all that apply. Elem. Ed. English Ed. Math Ed. Science Ed. Special Ed. Social Science Ed. English (Lit., Writing) Math Biology Chemistry Earth Science Environ. Science General Science Physics Social Sciences (Psych., Soc., History) Art General Studies Tech./Computer Science Curriculum/ Instruction Education Other AA/AS AA/AS Elem. Ed.AA/AS English Ed.AA/AS Math Ed.AA/AS Science Ed.AA/AS Special Ed.AA/AS Social Science Ed.AA/AS English (Lit., Writing)AA/AS MathAA/AS BiologyAA/AS ChemistryAA/AS Earth ScienceAA/AS Environ. ScienceAA/AS General ScienceAA/AS PhysicsAA/AS Social Sciences (Psych., Soc., History)AA/AS ArtAA/AS General StudiesAA/AS Tech./Computer ScienceAA/AS Curriculum/ InstructionAA/AS EducationAA/AS OtherBA/BS BA/BS Elem. Ed.BA/BS English Ed.BA/BS Math Ed.BA/BS Science Ed.BA/BS Special Ed.BA/BS Social Science Ed.BA/BS English (Lit., Writing)BA/BS MathBA/BS BiologyBA/BS ChemistryBA/BS Earth ScienceBA/BS Environ. ScienceBA/BS General ScienceBA/BS PhysicsBA/BS Social Sciences (Psych., Soc., History)BA/BS ArtBA/BS General StudiesBA/BS Tech./Computer ScienceBA/BS Curriculum/ InstructionBA/BS EducationBA/BS OtherMA/MS MA/MS Elem. Ed.MA/MS English Ed.MA/MS Math Ed.MA/MS Science Ed.MA/MS Special Ed.MA/MS Social Science Ed.MA/MS English (Lit., Writing)MA/MS MathMA/MS BiologyMA/MS ChemistryMA/MS Earth ScienceMA/MS Environ. ScienceMA/MS General ScienceMA/MS PhysicsMA/MS Social Sciences (Psych., Soc., History)MA/MS ArtMA/MS General StudiesMA/MS Tech./Computer ScienceMA/MS Curriculum/ InstructionMA/MS EducationMA/MS OtherEdS EdS Elem. Ed.EdS English Ed.EdS Math Ed.EdS Science Ed.EdS Special Ed.EdS Social Science Ed.EdS English (Lit., Writing)EdS MathEdS BiologyEdS ChemistryEdS Earth ScienceEdS Environ. ScienceEdS General ScienceEdS PhysicsEdS Social Sciences (Psych., Soc., History)EdS ArtEdS General StudiesEdS Tech./Computer ScienceEdS Curriculum/ InstructionEdS EducationEdS OtherPhD/EdD PhD/EdD Elem. Ed.PhD/EdD English Ed.PhD/EdD Math Ed.PhD/EdD Science Ed.PhD/EdD Special Ed.PhD/EdD Social Science Ed.PhD/EdD English (Lit., Writing)PhD/EdD MathPhD/EdD BiologyPhD/EdD ChemistryPhD/EdD Earth SciencePhD/EdD Environ. SciencePhD/EdD General SciencePhD/EdD PhysicsPhD/EdD Social Sciences (Psych., Soc., History)PhD/EdD ArtPhD/EdD General StudiesPhD/EdD Tech./Computer SciencePhD/EdD Curriculum/ InstructionPhD/EdD EducationPhD/EdD OtherAdditional comments:6) Which employment positions have you held? Please select all that apply.Teacher/Professor Substitute Teacher Curriculum Specialist Media Specialist Administrator Technology Specialist Department Chairperson Item/Passage Writer with a publishing company Item Scorer Editor/Item Editor Artist/Graphic Artist Content Specialist/Reviewer with a publishing company Bias/Sensitivity Reviewer Translator or Interpreter Freelance Writer Other (please specify) If you selected other, please specify:7) Which educational levels are you certified to teach? Please select all that apply.Early Childhood/Preschool Elementary Middle School Secondary Postsecondary N/A 8) In which states are you certified to teach? Please enter state abbreviations only (i.e., IL, CA, FL) or indicate National Certification.9) Which grade levels have you taught in a scholastic setting? Please select all that apply.Early Childhood Kindergarten 1 2 3 4 5 6 7 8 9 10 11 12 Postsecondary 10) How many years have you taught in a scholastic setting?1-2 years 3-5 years 6-9 years 10 or more years N/A 11) Which content areas have you taught in a scholastic setting? Please select all that apply.English/Language Arts Reading Writing Elementary/Middle School Math Pre-Algebra Algebra I Algebra II Geometry Statistics Pre-Calculus Biology Chemistry Physics Earth or Environmental Science Life Science Physical Science General Science Civics Economics Government Geography American History General Social Studies World History Other (please specify) If you selected other, please specify:12) In what roles have you worked for a test development company or state department of education? Please select all that apply.Item Writer Content Reviewer Bias/Sensitivity Reviewer Copy Editor Artist/Graphic Artist Reviewer of State Assessments Professional Scorer Project Management N/A Other (please specify) If you selected other, please specify:13) Which test development roles do you prefer?Artist/Graphic Artist Copy Editor Item Writer Passage Writer/Researcher Researcher (copyright and/or facts) Content Reviewer/Consultant 14) Which subject areas do you prefer? Rank your top 3 preferences.1)Choose OneEnglish/Language ArtsReadingWritingAlgebraGeometryGeneral MathBiologyChemistryPhysicsEarth ScienceLife ScienceEnvironmental SciencePhysical ScienceGeneral ScienceCivicsEconomicsGovernmentGeographyAmerican HistoryWorld HistoryGeneral Social StudiesOther2)Choose OneEnglish/Language ArtsReadingWritingAlgebraGeometryGeneral MathBiologyChemistryPhysicsEarth ScienceLife ScienceEnvironmental SciencePhysical ScienceGeneral ScienceCivicsEconomicsGovernmentGeographyAmerican HistoryWorld HistoryGeneral Social StudiesOther3)Choose OneEnglish/Language ArtsReadingWritingAlgebraGeometryGeneral MathBiologyChemistryPhysicsEarth ScienceLife ScienceEnvironmental SciencePhysical ScienceGeneral ScienceCivicsEconomicsGovernmentGeographyAmerican HistoryWorld HistoryGeneral Social StudiesOther15) Which grade levels do you prefer? Rank your top 3 preferences.1)Choose OneEarly ChildhoodElementary School (K-5)Middle School (6-8)High School (9-12)Postsecondary2)Choose OneEarly ChildhoodElementary School (K-5)Middle School (6-8)High School (9-12)Postsecondary3)Choose OneEarly ChildhoodElementary School (K-5)Middle School (6-8)High School (9-12)Postsecondary16) What is your work availability?Year-round Spring Summer Fall Winter
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