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Implementing School-Based Programs:
Nuts & Bolts
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MICHIGAN DEPARTMENT OF
EDUCATION
SCHOOL HEALTH PROGRAMS UNIT
Request for Approval of Sex Education Supervisor
Date: ____________________ Name of School District:____________________________
Name of Candidate for Supervisor of Sex Education:_________________________________
| 1. | The above candidate for Supervisor of Sex Education is: (Check all that apply) | |
| ____ | a physician licensed to practice in Michigan | |
| ____ | a nurse licensed to practice in Michigan | |
| ____ | an
educator who possesses a
valid Michigan’s teaching
certificate and has 3 years
of experience in health
education instruction or related area (Please specify the related area: ) |
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| 2. | If the candidate is an educator possessing the above certification and teaching experience, please identify his or her preservice or inservice training in sex education: (Check all that apply) | |
| ____ | An undergraduate or graduate course in sex education or human sexuality, which included information on human reproduction, family planning, marriage and family relations, and sexually transmitted diseases including HIV infection. | |
| ____ | A twenty (20) clock hour inservice in Human Reproductive
Health. Date and Location of training: |
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| ____ | Other
preparation that meets district’s requirements to teach sex
education. (Please attach copy of district’s requirements and briefly describe preparation below)
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I have reviewed the credentials of the above named candidate for Supervisor of the Sex Education Program in my school district and certify that the above information is correct.
| Name and Title of District Administrator Reviewing the Candidate’s Credentials: | Signature: |
| ______________________________________ | ______________________________________ |
| Address:
______________________________________ |
Phone
Number
______________________________________ |
This page last last updated on: 01/02/02
