Evaluation Certification Reimbursement Program

Evaluation Certification Reimbursement Program Application
The purpose of this funding opportunity is to help increase the number of Educational Diagnosticians and School Psychologists in the small and rural schools across Texas.

In order to be considered for financial assistance for a certification program, please complete this application. Prior to submitting this application, you must be currently enrolled in classes towards your certification.
Are you currently enrolled AND taking classes for your certification program? If not, you will be ineligible for financial assistance.*
If currently enrolled and taking classes, please upload documentation of your current class schedule:

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Date*

MonthDayYear
Date
Applicant Information
Name*

First NameLast Name
Work Email*
Personal Email
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Employment Information
Current Job Title*
LEA Name (Where Currently Employed)*
LEA CDN (County District Number)*
Is the LEA part of a SPED Coop/SSA?*
ESC Region #*
Supervisor's Name*
Supervisor's Job Title*
Supervisor's Phone Number*
Supervisor's Email*
Name of LEA/Coop Special Education Director (if not supervisor)
Special Education Director Email Address (if not supervisor)
Superintendent's Name*
Average Current Caseload for Diagnosticians in the LEA/Coop*
Average Current Caseload for LSSPs in the LEA/Coop*
How many Diagnostician positions are currently posted?*
How many LSSP positions are currently posted?*
Is the LEA/Coop currently contracting with a Diagnostician to provide services?*
Is the LEA/Coop currently contracting with a LSSP to provide services?*
Certification Program Information

*TEA does not endorse any of the below mentioned certification programs.
Are you currently enrolled in a certification program?*
Certification Currently Working Towards*
Program of Interest*
If "other" chosen above, please list university name:
Will completion of your certification program result in a bilingual certificate?
Do you plan to take classes towards your certification program in Spring, 2025?*
Including the hours you are taking this semester, how many credit hours remain before you graduate?*
Anticipated Graduation Date*
Describe your professional background, experiences, and professional goals which make you a good candidate for the evaluation certification program:*
Describe how you would be a good fit for working in a small or rural LEA:*
Assurances (must check all to be considered)*

At the end of each school year, I will submit proof of plans to continue working in a small/rural LEA or SSA.Once certified, I will continue working in a small/rural LEA or SSA for at least three years.
Should be Empty:

Evaluation Certification Reimbursement Program Application

Applicant Information

Employment Information

Certification Program Information