Last 4 digits of SSN Telephone Number Last Name First Name Maiden/Previous Last Name Email Address Proficiency Statement I certify that _________________________________________has demonstrated proficiency in (applicant name) Lakota, Dakota, or Nakota oral and written language and culture with recognition from a regionally-accredited institution of higher education offering a teacher education program in Lakota studies or an organization approved by both a tribal government in South Dakota and the Department. Also, the individual has successfully completed a three-semester-hour methodology course directly related to teaching Lakota, Dakota, Nakota language from a regionally-accredited institution of higher education. Printed Name of Authorized Official Print Title of Authorized Official Email Address Telephone Number Address City State Zip Code Signature of Authorized Official Date Save the completed form as a PDF and Email to
Last 4 digits of SSN Telephone Number Last Name First Name Maiden/Previous Last Name Email Address Proficiency Statement I certify that _________________________________________has demonstrated proficiency in (applicant name) Lakota, Dakota, or Nakota oral and written language and culture with recognition from a regionally-accredited institution of higher education offering a teacher education program in Lakota studies or an organization approved by both a tribal government in South Dakota and the Department. Also, the individual has successfully completed a three-semester-hour methodology course directly related to teaching Lakota, Dakota, Nakota language from a regionally-accredited institution of higher education. Printed Name of Authorized Official Print Title of Authorized Official Email Address Telephone Number Address City State Zip Code Signature of Authorized Official Date Save the completed form as a PDF and Email to
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