First Name:   Last Name: 

School:   District:   ESC:  None 1 - Edinburg 2 - Corpus Christi 3 - Victoria 4 - Houston 5 - Beaumont 6 - Huntsville 7 - Kilgore 8 - Mt. Pleasant 9 - Wichita Falls 10 - Richardson 11 - Fort Worth 12 - Waco 13 - Austin 14 - Abilene 15 - San Angelo 16 - Amarillo 17 - Lubbock 18 - Midland 19 - El Paso 20 - San Antonio Private School Outside of Texas

Mailing Address:

City:   State: 

Country:   Zip Code: 

Telephone Number:   E-mail Address: 

Preferred Contact Method:  None E-mail Postal Mail Telephone Personal Visit

What university did you get your Undergraduate Degree from:   
Undergraduate Major Field of Study: 

What university did you get your Master’s Degree from:   
Master’s Major Field of Study: 

What university did you get your Teacher’s Certification from: 

What university did you get your Library Certification from: 

Is your Library Certification by exam only? Yes No

How many years of Library Experience do you have? less than three three or more

Are you currently in a school library? Yes No

Short Biography:

Statement of Job Responsibilities:

School Library Experience:
List beginning and ending dates and levels - 3 years minimum required: