Contact Details

Prefix/Salutation

--None-- Mr. Ms. Mrs. Dr. Prof. Gen. The Hon. Rev. Dean

First Name

Last Name

Email

Other Email:

Address

City

State/Province

Zip

Phone

Mobile

Occupation Details

Current Position:

Current School/Organization:

Grade Level(s): (Check all that apply.)

Pre-K    K   
1    2    3    4    5    6  
7    8    9    10   11   12  

Subject Areas:

Is this an open enrollment (non-selective) school?

--None--Yes No

Is this a public school?

--None-- Yes No

Current Principal/Supervisor*:

Current Principal/Supervisor* Email:

* This is optional information. However, if you choose to apply to the program, we will require a Letter of Recommendation from your school principal.

Please list your years of Full-Time K-12 Teaching Experience (does not include student teacher experience):

Will you be in a school leadership role in New Orleans Parish for academic year 2008-2009?

--None-- Yes, as a Grade Level Head Teacher, Mentor Teacher, or Team Leader. Yes, as a Subject Area Head Teacher, Mentor Teacher, or Team Leader. Yes as a Dean, Assistant Principal or Department Chair. Yes, but I am seeking out such a role at this time. No, but I aspire to be in a leadership role for 2009-2010. I hope to be promoted from my current role to a
teacher-leader role within my school.

Program Interest

What is your most immediate professional development need? (Please select all that apply.)

Improving Instruction Student Assessment Data English/Literacy Curriculum Design Math/Numeracy Curriculum Design Science Curriculum Design Social Studies Curriculum Design Academic Support and Intervention Building Culture of Shared Values Behavior Management Mental Health/Counseling for Students Special Education/Inclusion Strategies Motivational School Culture Engaging with Parents Community and Strategic Partnerships Mentoring and Motivating Peers Personal Leadership Development Understanding Our Community Interpersonal/Team Communication Leading Mission-Focused Teams Other

If Other, please specify:

Summer Availability: Are you available this summer for a week-long institute starting July 21?

--None-- Yes No

Questions/Comments:

How did you hear about Leading Educators?