AFT/BTU Teacher Leaders Program 2018-19

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First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Best Contact Phone Number *

Personal Email Address *

School Name *

School Phone Number *

School Number *

Work Email Address *

Are you a tenured teacher? *

Are you a full member of the Baltimore Teachers Union *

Did you earn an Effective or Highly Effective evaluation SY 2017-18 *

Will you be able to be fully present at each of the program's sessions? *

Please list the subject that you are currently teaching and any of the other subjects that you have taught. *

How many years have you taught in BCPS? If you have teaching experience in another school district, indicate that as well. *

What are your areas of interest in education and education policy? *

Essay: Please write a short essay ( approximately two-typed, double spaced pages max.) describing an initiative in which you were an active participant who was charged with producing positive classroom or school change. Be specific about your role.

Recommendations: Please attach two letters of support. Appropriate references would be from your principal, BTU BR or Union Chapter Chair, colleague, student, parent, or other individual who can speak to your leadership abilities and school improvement efforts.

I have read and understand that I agree to make the following commitments: *

I will be available by email on a regular basis

I will attend each of the full-day Saturday meetings from 9:00am - 4:00pm

I will complete and be prepared to discuss the assigned readings related to education policymaking

I will participate in conducting research and other documentation

I will submit a press release to a media outlet

I understand that attendance for the is program is MANDATORY

I understand that a missed session or sessions may/will result in a reduction in the stipend received

DISCLAIMER and SIGNATURE I certify that my answers are true and complete to the best of my knowledge. If this application leads to ACCEPTANCE, I understand that false or misleading information in my application or interview may result in my release from the program. Indicating YES serves as my signature and agreement to the aforementioned statements. *