North Carolina American Sign Language Teachers Association
Sign Language Proficiency Interview in American Sign Language
(NC ASLTA SLPI: ASL)
Application form
Name: ________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________Email address: ____________________________________________________________
VP number: ____________________________________________________________
Check which plan you want:
______ Full report with diagnostic feedback. Fee: $125
______ Report informing you whether you have achieved a rating of at
least Advanced Plus or not. Fee: $85
If you chose the $85 option, and you later change your mind and
want the full diagnostic feedback, the upgrade fee is $105.
Agreement:
I agree that I have the right to file an appeal if I am not satisfied with the rating given by NC ASLTA SLPI: ASL within 30 days from the date of the letter informing me of the rating. The decision made by the appeal team will be final. I waive my right to file any legal action against NC ASLTA for any reason associated with the NC ASLTA SLPI: ASL. I will not hold NC ASLTA responsible for any effect upon my employment, including promotion or tenure.
___________________________________ ___________________________________
Name Name of Notary
Name of Notary___________________________________ ___________________________________
Signature of Candidate Signature of Notary
Signature of Notary___________________________________ ___________________________________
Date Date
DateMail this form and payment to:
Kathy Apperson, Statewide Coordinator
NC ASLTA SLPI: ASL
4109 Spreading Oaks Court
Waxhaw, North Carolina 28173
If you have any questions, contact Kathy Apperson at
NCASLTA-SLPI-ASL@msn.com
