Local Assignment Option Form

Local Assignment Option Form
School Name*
School Year*
Regional Coordinator*

Sarah ElliottMarnee ReevesPriscilla BillingsJeanette RedstoneChristie ChamblessMonique VerdinCharity RoveloAshley WarmuthAshley GriffithKacy CoalwellSharon DonovanAmy GrumblesCarly Boyd-DovideoCarin BeardNicole GallellaBethany RubinoSharon JosephRachel EmbryAdministrator
Teacher Name*

First NameLast Name
Teacher Email Address*
example@example.com
List all active (not expired) California Credential(s) Held (Subject Area)*
Subject Assignment(s) for Which Approval is Requested: If you have *

ArtEnglishMathematicsMusicPhysical EducationScienceSocial ScienceSpecial EducationForeign LanguageElectiveOther
If you have High School students or may get High School students in the future, you want to check all of the above. If you have a SPED student or may have a SPED student in the future, make sure to check off the Special Education box.
Education Code §44865 A valid teaching credential issued by the State Board of Education or the Commission for Teacher Preparation and Licensing, based on a bachelor’s degree, student teaching, and special fitness to perform, shall be deemed qualifying for assignment as a teacher in the following assignments, provided that the assignment of a teacher to a position for which qualifications are prescribed by the section shall be made only with the consent of the teacher:

(a) Home teacher
(b) Classes organized primarily for adults
(c) Hospital classes
(d) Necessary small high schools
(e) Continuation schools
(f) Alternative Schools
(g) Opportunity Schools
(h) Juvenile court schools
(i) County community schools
(j) District community day school
(k) Independent Study
Teacher Signature*

Clear
Should be Empty: