{"id":2082,"date":"2021-10-09T22:57:54","date_gmt":"2021-10-09T22:57:54","guid":{"rendered":"https:\/\/masondixonhomeschoolers.org\/home\/?page_id=2082"},"modified":"2021-10-09T22:57:54","modified_gmt":"2021-10-09T22:57:54","slug":"elementary-evaluator-listing-request","status":"publish","type":"page","link":"https:\/\/masondixonhomeschoolers.org\/home\/elementary-evaluator-listing-request\/","title":{"rendered":"Elementary Evaluator Listing Request"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-2081\"><form id=\"wpforms-form-2081\" class=\"wpforms-validate wpforms-form\" data-formid=\"2081\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/home\/wp-json\/wp\/v2\/pages\/2082\" data-token=\"49a3cec631271d45508ec563d6dc981b\" data-token-time=\"1779243203\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-2081-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_4\">Please list the county\/counties in Pennsylvania where you evaluate students. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2081-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-2081-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_0\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2081-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-2081-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2081-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-2081-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-2081-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_1\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2081-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-2081-field_12-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_12\">Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2081-field_12\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][12][address1]\" required><label for=\"wpforms-2081-field_12\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2081-field_12-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][12][address2]\" ><label for=\"wpforms-2081-field_12-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2081-field_12-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][12][city]\" required><label for=\"wpforms-2081-field_12-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2081-field_12-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][12][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AL\" >Alabama<\/option><option value=\"AK\" >Alaska<\/option><option value=\"AZ\" >Arizona<\/option><option value=\"AR\" >Arkansas<\/option><option value=\"CA\" >California<\/option><option value=\"CO\" >Colorado<\/option><option value=\"CT\" >Connecticut<\/option><option value=\"DE\" >Delaware<\/option><option value=\"DC\" >District of Columbia<\/option><option value=\"FL\" >Florida<\/option><option value=\"GA\" >Georgia<\/option><option value=\"HI\" >Hawaii<\/option><option value=\"ID\" >Idaho<\/option><option value=\"IL\" >Illinois<\/option><option value=\"IN\" >Indiana<\/option><option value=\"IA\" >Iowa<\/option><option value=\"KS\" >Kansas<\/option><option value=\"KY\" >Kentucky<\/option><option value=\"LA\" >Louisiana<\/option><option value=\"ME\" >Maine<\/option><option value=\"MD\" >Maryland<\/option><option value=\"MA\" >Massachusetts<\/option><option value=\"MI\" >Michigan<\/option><option value=\"MN\" >Minnesota<\/option><option value=\"MS\" >Mississippi<\/option><option value=\"MO\" >Missouri<\/option><option value=\"MT\" >Montana<\/option><option value=\"NE\" >Nebraska<\/option><option value=\"NV\" >Nevada<\/option><option value=\"NH\" >New Hampshire<\/option><option value=\"NJ\" >New Jersey<\/option><option value=\"NM\" >New Mexico<\/option><option value=\"NY\" >New York<\/option><option value=\"NC\" >North Carolina<\/option><option value=\"ND\" >North Dakota<\/option><option value=\"OH\" >Ohio<\/option><option value=\"OK\" >Oklahoma<\/option><option value=\"OR\" >Oregon<\/option><option value=\"PA\" >Pennsylvania<\/option><option value=\"RI\" >Rhode Island<\/option><option value=\"SC\" >South Carolina<\/option><option value=\"SD\" >South Dakota<\/option><option value=\"TN\" >Tennessee<\/option><option value=\"TX\" >Texas<\/option><option value=\"UT\" >Utah<\/option><option value=\"VT\" >Vermont<\/option><option value=\"VA\" >Virginia<\/option><option value=\"WA\" >Washington<\/option><option value=\"WV\" >West Virginia<\/option><option value=\"WI\" >Wisconsin<\/option><option value=\"WY\" >Wyoming<\/option><\/select><label for=\"wpforms-2081-field_12-state\" class=\"wpforms-field-sublabel after\">State<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2081-field_12-postal\" class=\"wpforms-field-address-postal wpforms-field-required wpforms-masked-input\" data-inputmask-mask=\"(99999)|(99999-9999)\" data-inputmask-keepstatic=\"true\" data-rule-inputmask-incomplete=\"1\" name=\"wpforms[fields][12][postal]\" required><label for=\"wpforms-2081-field_12-postal\" class=\"wpforms-field-sublabel after\">Zip Code<\/label><\/div><\/div><div class=\"wpforms-field-description\">Your address will NOT be included in your contact information. This is for MDHSA's use only.<\/div><\/div><div id=\"wpforms-2081-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_5\">Phone number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2081-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><div class=\"wpforms-field-description\">Please indicate whether you prefer texts or calls at this number. If you accept both at this number, write \"calls\/texts.\"<\/div><\/div><div id=\"wpforms-2081-field_13-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_13\">Evaluator Qualifications: Check one of the boxes below to indicate which criteria required by the PA Home Education Law you meet to qualify as a homeschool evaluator of elementary students. <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2081-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2081-field_13_1\" name=\"wpforms[fields][13][]\" value=\"Licensed clinical psychologist or certified school psychologist\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2081-field_13_1\">Licensed clinical psychologist or certified school psychologist<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-2081-field_13_4\" name=\"wpforms[fields][13][]\" value=\"PA certified public school teacher or administrator with 2 years of elementary (K-6th) grading experience in any of the following subjects: English, to include spelling, reading and writing; arithmetic; science; geography; history of the United States and Pennsylvania; and civics.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2081-field_13_4\">PA certified public school teacher or administrator with 2 years of elementary (K-6th) grading experience in any of the following subjects: English, to include spelling, reading and writing; arithmetic; science; geography; history of the United States and Pennsylvania; and civics.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-2081-field_13_2\" name=\"wpforms[fields][13][]\" value=\"Nonpublic (private) school teacher or administrator with 2 years of elementary (K-6th) teaching and grading experience in a PA public or nonpublic school in the past 10 years in any of the following subjects:  English, to include spelling, reading and writing; arithmetic; science; geography; history of the United States and Pennsylvania; and civics.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2081-field_13_2\">Nonpublic (private) school teacher or administrator with 2 years of elementary (K-6th) teaching and grading experience in a PA public or nonpublic school in the past 10 years in any of the following subjects:  English, to include spelling, reading and writing; arithmetic; science; geography; history of the United States and Pennsylvania; and civics.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-2081-field_13_3\" name=\"wpforms[fields][13][]\" value=\"Individual with other qualifications (than those listed in the home education law) who has received  prior consent of the district residence superintendent to evaluate secondary students.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2081-field_13_3\">Individual with other qualifications (than those listed in the home education law) who has received  prior consent of the district residence superintendent to evaluate secondary students.<\/label><\/li><\/ul><div class=\"wpforms-field-description\">I understand by checking one of the above boxes that I certify and affirm that I possess the necessary credentials and\/or meet the criteria set forth in the PA Home Education Law to evaluate homeschooled students. I also understand that a family may request proof of my qualifications when consulting me as an evaluator.<\/div><\/div><div id=\"wpforms-2081-field_11-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"11\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_11\">If you are an evaluator with other qualifications who has received prior consent of a shool district superintendent to evaluate elementary students, please list the name(s) of the school district(s) in which you have been approved as an evaluator. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2081-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-2081-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_7\">If you are qualified to pre-approve objectives for students with IEPs and wish that information to be added to your contact information, please check the box below.<\/label><ul id=\"wpforms-2081-field_7\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2081-field_7_1\" name=\"wpforms[fields][7]\" value=\"Yes, I am qualified to pre-approve objectives for students with IEPs.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2081-field_7_1\">Yes, I am qualified to pre-approve objectives for students with IEPs.<\/label><\/li><\/ul><\/div><div id=\"wpforms-2081-field_9-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_9\">If you would like your contact information to include a notice that you offer virtual evaluations, please check the box below.<\/label><ul id=\"wpforms-2081-field_9\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2081-field_9_1\" name=\"wpforms[fields][9]\" value=\"Yes, I offer virtual evaluations.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2081-field_9_1\">Yes, I offer virtual evaluations.<\/label><\/li><\/ul><\/div><div id=\"wpforms-2081-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_10\">If you can evaluate elementary through 8th grade or if you evaluate only certain elementary grades, please list that information here.<\/label><input type=\"text\" id=\"wpforms-2081-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><div class=\"wpforms-field-description\">Please know that even if you have approval to evaluate high students, it will be be shown on the elementary evaluator listing since MDHSA requires all high school evaluators to be approved MDHSA Diploma Program evaluators. See the Diploma Program website for more details.<\/div><\/div><div id=\"wpforms-2081-field_14-container\" class=\"wpforms-field wpforms-field-captcha\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_14\">To show us you are not a bot, please answer the following math question. <span class=\"wpforms-required-label\">*<\/span><\/label><p id=\"wpforms-2081-field_14-question\" class=\"wpforms-captcha-question\">What is 7+4?<\/p>\n\t\t<input type=\"text\" id=\"wpforms-2081-field_14\" class=\"wpforms-field-medium wpforms-field-required a\" data-rule-wpf-captcha=\"qa\" data-is-wrapped-field=\"1\" data-a=\"11\" name=\"wpforms[fields][14][a]\" aria-describedby=\"wpforms-2081-field_14-question\" required>\n\t\t<input type=\"hidden\" name=\"wpforms[fields][14][q]\" value=\"1\">\n\n\t\t<\/div><div id=\"wpforms-2081-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2081-field_2\">Comments or Questions for MDHSA<\/label><textarea id=\"wpforms-2081-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"2081\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/pages\/2082\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2081\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-2082","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/pages\/2082","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/comments?post=2082"}],"version-history":[{"count":1,"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/pages\/2082\/revisions"}],"predecessor-version":[{"id":2083,"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/pages\/2082\/revisions\/2083"}],"wp:attachment":[{"href":"https:\/\/masondixonhomeschoolers.org\/home\/wp-json\/wp\/v2\/media?parent=2082"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}