APPLICATION FOR ANCILLARY CERTIFICATON
Educational Interpreter
Educational Transliterator
If renewal – Current Louisiana
Initial
Certificate Held:
Renewal
#
Verification of 90 CLUs
attached
Online Payment Confirmation #
Social Security Number :
Date of Birth:
Phone Number:
First Name:
Middle:
Maiden:
Last:
E-mail Address:
Employing School 6\VWHP:
Requested Certificate: Please check one
Educational Interpreter (ASL, PSE, SEE) OR Educational Transliterator (Cued Speech)
Provisional Educational
Interpreter
Qualified Educational
Interpreter
Provisional
Educational
Transliterator
Qualified Educational
Transliterator
This certificate is valid for one year
and can be held for a maximum of
three years. It must be renewed
annually at the request of the
Louisiana employing authority.
This certificate is renewable upon
completion of ten contact hours of
relevant professional development
annually. Course credit leading to
a Qualified Certificate may be
applied toward the ten hours.
These hours shall be accrued
beginning with the issuance of the
Provisional Educational Interpreter
Certificate.
Guidelines
for
Issuance
of
Provisional Certification
- Must
have evidence
of
one
of the
following:
Please
Check
Successfully Completed an
Interpreter Preparation Program
National Certification as a Sign
Language Interpreter
Possess SLPI or SCPI at
Specified Level
Possess Specified Level Pre-hire
EIPA
This certificate is valid for five years
and may be renewed every five
years at the request of
the
Louisiana
employing authority upon
completion of six semester hours of
credit or equivalent relevant
professional development (90
Contact Hours).
These hours shall be accrued
beginning with the date of
issuance of the currently held
Qualified Educational Interpreter
Certificate.
Guidelines
for
Issuance
of
Qualified Certification
– Must
have evidence
of
both
of the
following:
Please
Check
Pass the Educational Interpreter
Performance Assessment - written
test
Pass a standardized videotaped
version of the Educational
Interpreter Performance
Assessment at the Specified Level
This certificate is valid for one year
and can be held for a maximum of
three years. It must be renewed
annually at the request of the
Louisiana employing authority.
This certificate is renewable upon
completion of ten contact hours of
relevant professional development
annually. Course credit leading to
a Qualified Certificate may be
applied toward the ten hours.
These hours shall be accrued
beginning with the issuance of the
Provisional Educational
Transliterator Certificate.
Guidelines
for
Issuance
of
Provisional Certification
-
Must have evidence
of
one
of
the following:
Please
Check
National Certification as a Cued
Speech Transliterator
Pass the Cued American English
Competency Screening
This certificate is valid for five
years and may be renewed every
five years at the request of the
Louisiana employing authority
upon completion of six semester
hours of credit or equivalent
relevant professional development
(90 Contact Hours).
These hours shall be accrued
beginning with the date of
issuance of the currently held
Qualified Educational
Transliterator Certificate.
Guidelines
for
Issuance
of
Qualified Certification
– Must
have evidence
of
both
of the
following:
Please
Check
Pass the state sanctioned Cued
Language Transliterator written
assessment
Pass the Cued Language
Transliterator Performance
Assessment
or Educational
Interpreter Performance
Assessment – Cued Speech
(EIPA_CS) at the Specified Level
Note: An
individual who does
not
meet Qualified Educational Interpreter/Transliterator requirements may apply
for a
provisional
certificate.
To be
signed
by
Louisiana employing school system
authority:
I hereby request the LVVXDQFHRUrenewal RI this individual’s Ancillary Interpreter certificate:
______________________________________________________
Signature of employing School/School 6\VWHP Date
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