Semiannual Employee Certification Complete this certification form for the selected period. Δ Semi-Annual Period(Required)Please SelectJuly – DecemberJanuary – JuneFiscal Year(Required)Please Select2024 – 20252025 – 20262026 – 20272027 – 20282028 – 20292029 – 20302030 – 20312031 – 20322032 – 20332033 – 20342034 – 2035Employee Name(Required) First Last Employee Email(Required) Program/Activity/Description(Required)Please SelectCLSD 3.0CLSD Literacy CoachCLSD Literacy MentorClass Size Reduction TeacherFed Programs DirectorFed Programs SecretaryHSEMedia SpecialistPre-K ParaprofessionalPre-K TeacherTech CoordinatorTitle 1 FacilitatorAnticipated Effort(Required)Please Select100%Total Actual Effort(Required)Please Select100%Certification Acknowledgement(Required) I certify that the information above is true and accurate.I hereby certify that in the period of time noted above, I spent 100% of my time on the above-referenced program Grant Parish. This report is an after the fact determination of the total activity and actual effort expended for the period indicated, and I have full knowledge of these activities. Signature(Required)Your NameYour NameYour NameYour Name
