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| If you have questions or need information, please contact Cathy Shank at cshank@access.k12.wv.us or 1-800-257-3723 ext. 112. |
| SECTION 1: TRAINEE/CLASS INFORMATION |
| Trainee name | |
| First | | |
| Middle initial | | |
| Last | | |
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| Email | | |
| Please indicate if this email address is likely to change (e.g., individual is applying for an access email account) | |
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| Already involved or previously worked with WVABE? | |
| Has the individual been trained or employed by WVABE? Is the person already in the AEMIS database? | |
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| If so, when? | | |
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| Grantee's RESA | | |
| AEMIS Grantee (Fiscal agent/local program that pays the instructor.) | | |
| For SPOKES instructors, the grantee is usually the RESA.
For institutional ed, the grantee is usually the facility.
For other programs, the grantee is often the county. | |
| Class location | | |
| Class schedule | | |
| Trainee's Personal/Home Mailing Address |
| Address | | |
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| City | | |
| State | | |
| Zip | | |
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| Phone number at class site | | |
| If unsure of the class phone, use the person's home or cell phone. | |
| Home phone | | |
| Cell phone, if any | | |
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| SECTION 2: PREDECESSOR INFORMATION |
| Name of predecessor (if any) Who was the previous person in this position? | |
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| Should the predecessor be deactivated in AEMIS? Only deactivate if the person will no longer work with WVABE in any capacity. | |
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| If not, what is the predecessor's new role/status? What is the predecessor's new position or location? | |
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| SECTION 3: EMPLOYMENT INFORMATION |
| New Trainee's Employment Status | |
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| Total Paid Hours/Week (including planning and administrative tasks) | | |
| Instructional Hours/Week (time with students only) | | |
| Type of Specialty Training Needed (Check all that apply.) | |
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| SECTION 4: TRAINEE CERTIFICATION/LICENSURE |
| Type of credential: | |
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| Status of Certification: | |
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| Expiration Date (or please indicate if the credential is permanent or pending) | | |
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| SECTION 5: LOCAL ADMINISTRATOR INFORMATION |
| Person Making Request: | |
| First | | |
| Last | | |
| Email | | |
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| Daytime phone | | |
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| SECTION 6: AEMIS USER TRAINING |
| AEMIS User training is not automatically part of pre-service training. Your local Data Manager is the person responsible for: |
- ensuring that student data is entered accurately and in a timely fashion for your local classes.
- creating class sites and classes at the local level.
- ensuring that instructors in the local program enter data correctly.
- providing assistance to new instructors within the first two months of employment.
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| Who is the AEMIS Data Manager for your Grantee that will train the new staff member? | |
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| What is the plan for having the AEMIS Data Manager meet with the new staff member regarding AEMIS? | |
| (Please contact Louise Miller at 304-256-4712 ext. 1122 for assistance with AEMIS training requests.) | |
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| SECTION 7: HIRING/TRAINING INFORMATION |
| Anticipated hiring date | | |
| Date of 1st class | | |
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| It is the local administrator's responsibility to approve the observation site and inform the trainee of travel reimbursements (if any). If the site is within your county, please go ahead and set it up with the instructor you want the trainee to visit. | |
| Preferred Location for Job Shadowing / Observation (if any) |
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| Preferred Peer Trainer (if any) |
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| Other Notes, Questions or Concerns | | |
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