Form Ddd-1691a - Article 9 Instructor Application Packet (Page 2 of 8) in pdf

Form Ddd-1691a - Article 9 Instructor Application Packet Page 2

DDD-1691A FORFF (11-17)

Page 2 of 8

Additional Required Attachments:

Attached?

Article 9 Candidate Assessment ................................................................

Signed Instructor Responsibilities Agreement ...........................................

Letter of Support and Agreement from Supervisor/Agency ........................

Send completed application and required attachments to dddstatewidetraining@azdes.gov.

If you have questions about completing this application, please contact the DDD Training Unit at 602-771-8125.

Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the

Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of

1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination

in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability,

genetics and retaliation. To request this document in alternative format or for further information about this policy, contact

the Division of Developmental Disabilities ADA Coordinator at 602-542-0419; TTY/TDD Services: 7-1-1. • Free language

assistance for DES services is available upon request.

Form Ddd-1691a - Article 9 Instructor Application Packet Page 2