School Director And/or Program Director Application Form
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1
2DIRECTOR FORM
SCHOOL NAME:
LOCATION: _________________________
Your school must submit one form for the School Director and/or Program Director. The Director has
responsibility and control over the main campus and any branches. The school must submit the
Director Form as part of the application for initial approval or renewal approval. Print clearly.
The school must submit a revised Hospital School Staff Roster (HPOSA AP Page 7) in conjunction
with each successive addition and deletion of a School Director and/or Program Director.
SCHOOL DIRECTOR NAME: ______________________________________________________
PROGRAM DIRECTOR NAME: _____________________________________________________
Beginning Date: __________________________________________________________________
QUALIFICATIONS:
The School Director must complete each question below.
1) I hold a high school diploma, or other equivalency
recognized by the Board of Education (G.E.D.)
Yes
No
and
2) I have a minimum of five years experience in the area
Yes
No
for which training is offered,
or
I hold an undergraduate diploma from a four-year college
and
Yes
No
N/A
I have a minimum of three years of experience in the area
of training being offered.
or
If the school offers instruction in an area in which I
am not qualified, the department head or supervising
Yes
No
N/A
instructor shall have the above qualifications.
and
3) I am experienced in administration, if yes list number
Yes
No
of years________________
EDUCATION AND EXPERIENCE
-Attach a current copy of your resume
-Attach a copy of your teacher certificate and/or occupational license (if applicable)
(8/2012)
HPOSA AP Page 8
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