<p> APPLICATION AND CHECKLIST FOR DSPS LD ELIGIBILITY and SERVICES MODEL (LDESM) TRAINING</p><p>LD Training Date: January 8-10, 2016 Application Deadline: Emailed by November 20, 2015</p><p>Name:______</p><p>Email: ______Alternate Email: ______</p><p>Phone (Work):______Phone (Home) :______</p><p>College where employed: or None</p><p>Home Address: ______</p><p>City:______State: ______Zip:______</p><p>Check one selection for item 1 and both selections for item 2, and submit the required documentation including the supplementary form for interns if appropriate.</p><p>1a. Verification of employment in an LD specialist or LD instructor position at a California community college. The verification must state that you meet the college's minimum qualifications for instructor or specialist in the area of Learning Disabilities. (Note: In accordance with district/college policy, equivalency criteria may be used to meet the minimum qualifications.) Documentation must be from your DSPS Coordinator or Human Resources/Personnel Director, 1b. ____ Verification of California Community College employment in a position other than LD. Documentation of employment must be from your college’s Human Resources/Personnel Director and must state the position for which you were hired. Verification of qualifications must be substantiated by submitting the documentation specified in 1c below, 1c. Verification that you hold a minimum of a Master's degree in (a) learning disabilities or (b) any of the following areas (including a minimum of 15 semester units of upper division or graduate study in the area of learning disabilities): special education, education, psychology, educational psychology or rehabilitation counseling. Documentation of LD-focused courses must accompany this application. This may be a copy of college transcripts and course descriptions, or a copy of a California Community College Credential with a specialization in Learning Disabilities, or a copy of the CSU Sacramento Adult LD certificate. Note: A list of sample LD courses is included on p. 2. 1d. ____ Verification of employment as an intern in a California Community College DSPS program. Documentation must be from the DSPS Coordinator or Human Resources/Personnel Director, with recommendation for your participation from the LD Supervisory (if applicable)</p><p>Documentation must include the completed form entitled Documentation of Internship Requirements for LD Training Applications.</p><p>Please note: Interns will not be awarded their certificate of completion of the LD training until they have completed their graduate degree. AND 2. Verification of appropriate training in cognitive assessment (Wechsler Adult Intelligence Scale-IV and/or Woodcock-Johnson III or IV Tests of Cognitive Abilities.) Please note, this is the last training in which the WJ III will be accepted for the training.</p><p>AND Verification of appropriate training in assessing achievement (Wechsler Individual Achievement Test-III (WIAT-III) and/or the Woodcock-Johnson III or IV (WJ III or IV) Tests of Achievement.) Please note, this is the last training in which the WJ III will be accepted for the training. Documentation must include one of the following: a. a copy of your college transcripts highlighting assessment course(s) and course outlines or catalog descriptions, or course syllabi; b. a letter from the instructor specifying the instruments in which you have been trained; c. a copy of certification of training through a professional organization, or CCC Chancellor’s Office sponsored training.</p><p>Survey courses in assessment are not sufficient to meet this requirement. Actual training with supervised practice in the administration, scoring, and interpretation of the instrument is essential for successful participation in and completion of the LD Eligibility Model Services Training.</p><p>Complete and email this checklist/registration form now to reserve a space. Failure to submit all required documentation may jeopardize acceptance into the training. If the training is full, a wait list will be established based on submission dates of completed applications. We have had last minute cancellations and can consider filling them only if completed application packets have been submitted.</p><p>Select one aptitude AND one achievement measure; you will be sent pre-tests to measure competency.</p><p>Aptitude: WJ III _____IV _____ or WAIS-IV ______</p><p>Achievement: WJ III _____IV _____ or WIAT-III ______</p><p>Email this form to Patricia Flores-Charter at [email protected] </p><p>The following general areas of coursework would be applicable toward meeting the 15-unit requirement for participating in the LD Eligibility Model Training:</p><p>Normal/disordered learning theory LD learning theory, assessment, or intervention Instructional methodologies for students with LD Psychology of Exceptional Individuals (with LD included) Counseling Exceptional Individuals (with LD included) Woodcock-Johnson Tests of Achievement (WJ III or IV) (with WJ III or IV Achievement included in the course description or syllabus) This is the last training in which the WJ III will be accepted for the training. Wechsler Individual Achievement Test-III (WIAT-III) (with WIAT III included in the course description or syllabus) WAIS IV (WISC IV) (with WAIS or WISC IV included in the course description or syllabus) Woodcock-Johnson Tests of Cognitive Abilities (WJ III or IV) (with WJ III or IV Cognitive included in the course description or syllabus) Please note: This is the last training in which the WJ III will be accepted for the training.</p><p>Below are examples of coursework in areas that will be considered:</p><p>Introduction to Learning Disabilities (Learning Handicaps) Abnormal Psychology/Atypical Cognitive Development Communication Disorders/Assessment Educational Counseling Rehabilitation Counseling Career Education Adults with Disabilities/Rehabilitation Counseling for Adults with Disabillities Adaptive Technology Disability in Family, School, and Community Special Education Curriculum/ Instruction/Teaching Strategies Practicum with Adults with Disabilities Teaching Reading (Math, Writing) to the LD (LH) Child (or Adult)</p><p>Coursework for Master Degrees in areas of disability are also considered; however, sufficient coursework in assessement of LD including theory, administration, scoring, interpretation and decision making is required.</p>