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| First Name: | |
| Last Name: | |
| Nickname: | |
| School / Company: | |
| Email Address: | |
| ementoring == "1"){ echo " checked";}?>> | Interested in eMentoring |
| gradcredits == "1"){ echo " checked";}?>> | Signing up for Grad Credits |
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Program Information
Enter any relevent Program information below: |
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| Program you are applying for: |
name." "; } while ($perms = mysql_fetch_object($permsql)); } else { print "None Chosen"; } ?> |
| Previous LTI Programs: |
graduated_programs);
foreach ($grad as $gid) {
$grp_sql = db_exec_sql("select name from groups where id = ".$gid." and program = 'Year I'", "webdb");
if (mysql_num_rows($grp_sql)) {
$grp = mysql_fetch_object($grp_sql);
print $grp->name." "; } } ?> |
| Previous LTII Programs: |
name." "; } } ?> |
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Contact Information
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| Home Address: | |
| Home Address (Cont.): | |
| City: | |
| State: | |
| Zipcode: | |
| Phone #: | |
| Cell #: | |
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Employment
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| School District (if applicable): | school_district; $dist_sql = db_exec_sql("select * from districts where id = ".$app->school_district, "webdb"); if (mysql_num_rows($dist_sql)){ $dist = mysql_fetch_object($dist_sql); print $dist->district; } ?> |
| Current School/Employer: | |
| School/Employer Website: | |
| Address: | |
| City: | |
| State: | |
| Zip: | |
| Phone #: | |
| Grade Level: | |
| Subject(s): | |
| Total # of Years Teaching: | |
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Other Subjects Taught
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| Subject: | |
| How many years: | |
| |
| Subject: | |
| How many years: | |
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Education
Please list education, training, and/or specialized programs. |
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| School: | |
| Major/Degree: | |
| Dates: | |
| |
| School: | |
| Major/Degree: | |
| Dates: | |
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Application Questions
Please limit your response to no more than one (1) paragraph per question: |
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| What special ways have you contributed to the school in which you teach? | |
| |
| How would you like Leadership Teacher to help you in that effort? | |
| |
| Please share some thoughts on how you might disseminate outcomes from participating in this program with your school or school district. | |
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Tuition
School District Cost: $700 for 1 teacher; $600 for 2 teachers; $500 for 3 or more teachers. School District Cost: $300/teacher; $275 for two or more teachers. School District Cost: $300/teacher; $275 for 2 or more teachers. School District Cost: $250/teacher. |
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Principal/Assistant Superintendent/Superintendent Confirmation
This application requires confirmation from either your school's Principal or your school's Assistant Superintendent or Superintendent. Please provide their email addresses below so that we can send them a copy of this application for their approval. |
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| Principal's Name: | |
| Principal's Email Address: | |
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| Asst Superintendent's Name: | |
| Asst Superintendent's Email Address: | |
| |
| Superintendent's Name: | |
| Superintendent's Email Address: | |