REF-1596.

6 November 7, 2013

LOS ANGELES UNIFIED SCHOOL DISTRICT Division of Special Education

ATTACHMENT A

SCHOOL ROSTER OF STAFF ELIGIBLE TO INTERPRET AT IEP TEAM MEETINGS SCHOOL YEAR 2013-2014

SUBMIT

DIRECTIONS: School staff are requested to thoroughly complete all sections of this fillable form* and submit to the Division of Special Education using the SUBMIT button above. Please ensure the completed form is received by the Division of Special Education no later than December 20, 2013 for the 2013-2014 school year, and October 15 of each school year thereafter. Thank you. *NOTE: To be considered eligible to provide oral interpretation at IEP team meetings, staff must meet all of the requirements for their job classification.

SECTION I: SCHOOL INFORMATION

School: Name of Person Completing Form: Principal Name: Loc Code: Telephone: Email Address: Educational Service Center:

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REF-1596.6 November 7, 2013

LOS ANGELES UNIFIED SCHOOL DISTRICT Division of Special Education

ATTACHMENT A

SECTION II (a): VERIFICATION OF ELIGIBILITY TO INTERPRET AT IEP MEETINGS

CLASSIFIED BILINGUAL STAFF

Classified Employee Name (Last, First)

Employee Number

Bilingual by District Standard

Completed LAUSD Knowledge of Special Oral Interpretation Education Training Terminology

Yes Yes Yes Yes Yes Yes Yes

No No No No No No No

Yes Yes Yes Yes Yes Yes Yes

No No No No No No No

Yes Yes Yes Yes Yes Yes Yes

No No No No No No No

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REF-1596.6 November 7, 2013

LOS ANGELES UNIFIED SCHOOL DISTRICT Division of Special Education

ATTACHMENT A

SECTION II (b): VERIFICATION OF ELIGIBILITY TO INTERPRET AT IEP TEAM MEETINGS

CERTIFICATED BILINGUAL STAFF

Completed LAUSD Oral Special Education A-Level Fluency, Interpreter Staff* BCC, or Training and/or BCLAD Received IEP Interpretation *If checked No for Special Education Staff, must indicate whether employee has Knowledge Protocol Knowledge of Special Education Terminology
of Special Education Terminology

Certificated Employee Name (Last, First)

Employee Number

Yes Yes Yes Yes Yes Yes Yes

No No No No No No No

Yes Yes Yes Yes Yes Yes Yes

No No No No No No No

Select Select Select Select Select Select Select

Yes Yes Yes Yes Yes Yes Yes

No No No No No No No

NOTE: Any site staff member who is currently being utilized or who will be utilized in the future by administrators to interpret, but who has not yet met any of the eligibility criteria above, must meet all of the eligibility criteria within six school months of the date of the IEP team meeting or within six months of the date of the IEP meeting in which the staff member was utilized to interpret or within six months after the site receives notice from the Division of Special Education of the number of eligible interpreters needed at the site in which the site staff member provided interpretation.

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