All fields required unless otherwise noted
Region of Interest:
--None--
Baton Rouge
Kansas City
Greater New Orleans
Washington D.C.
Salutation:
--None--
None
Dr.
Ms.
Mrs.
Miss
Mr.
First Name:
Last Name:
Street Address:
City:
State/Province:
--None--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
ZIP/Postal Code:
Teacher-Leader Preferred Email:
Teacher-Leader Secondary Email:
Preferred Phone:
--None--
Home Phone
Mobile Phone
Work Phone
Home Phone:
Phone format: 111-222-3333
Mobile Phone:
Phone format: 111-222-3333
Work Phone:
Phone format: 111-222-3333
Current Title:
School Name Next Year:
School District Name:
Enter "Recovery School District", if applicable.
County/Parish:
To select multiple items, press Ctrl while clicking each item with your mouse (Cmd+click on Mac.)
Grade Levels:
Select all that apply.
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
12+
Subject Areas:
Select all that apply.
English Language Arts
Fine Arts
Foreign Language
Mathematics
Science
Self-Contained
Social Studies
Special Education
Other
Subject Area, Other :
If you selected "Other," please define additional subject area experience.
Ethnicity: (optional)
Leading Educators is committed to a policy of equal treatment and opportunity in
every aspect of its relations with its applicants, fellows, and staff members,
without regard to race, color, ethnicity, religion, gender, sexual orientation,
national origin, disability, age, marital status, military status, pregnancy,
or parenthood.
--None--
American Indian or Alaska Native
Asian
Black or African American (not Hispanic or Latino)
Hispanic or Latino
Multiethnic / Multi Racial
Native Hawaiian or Other Pacific Islander
Other: Identify as a person of color
White, Caucasian
Teacher Leadership
In order to qualify for and be successful in the Fellowship, you must serve in a teacher-leader role next year managing at least two other adults,
and exhibit high leadership potential evidenced by outstanding results.
Teacher-Leader Role:
Please select the option closest to your anticipated role for the next academic year.
--None--
Assistant Principal
Classroom Teacher
Classroom Teacher and Mentor Teacher
Dean of Students
Multiple-subject teacher and team lead/ grade level chair
Out of Classroom Specialist (RtI, SPED, other)
PD Resource/Head of Curriculum and Instruction
Subject-matter teacher and department chair
Other
Teacher-Leader Role, Other :
If you selected "Other," please define the role not listed.
To select multiple items, press Ctrl while clicking each item with your mouse (Cmd+click on Mac.)
Teacher-Leader Responsibilities:
Select all that apply.
Lead Grade Level Meetings
Lead Department Meetings
Observation and Feedback, Other Teachers
Plan Professional Development
Coach Other Teachers
Monitor and Improve Student Culture
Coord. Response to Intervention Systems
Coord. Parent and Family Engagement
Coord. Special Education Services
Other: Please Specify
Other Teacher-Leader Responsibilities:
If you selected 'Other', please specify any additional responsibilities here.
Career Trajectory:
Where do you see yourself in three to five years?
Principal Endorsement:
Please share the name of the principal who supports your Leading Educators application.
We will send a note at the email address you provide with instructions on how to access
our "Endorse a Teacher-Leader" form on our website.
This endorsement form which includes a letter of recommendation are required from your supporting principal or school leader.
Supporting principals should be invested in your formal leadership development. In addition, principals must be willing to support
the conditions and a portion of the costs of the program.
Principal First Name:
Principal Last Name:
Principal Preferred Email:
Years Experience K-12:
Please estimate in decimals (e.g., 3.5) the amount of time that is not a full year and
ensure that the information provided below matches the information provided on your resume.
NOTE: Student teaching does NOT count toward the minimum teaching requirement and should not be
included in any of the work experience questions.
How many years of full-time K-12 classroom teaching experience will you have by this summer?:
Ex. 4 years 3 months = 4.25 yrs
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Affiliations,
Select all that apply:
None
College/University School of Education
The New Teacher Project
teachNOLA
Teach For America
Alternative Certification Program
Other
Affiliations, Other :
If you selected "Other," please define.
Please share your current teaching certificate information:
Certificate State:
--None--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Certificate Title:
Certificate Year:
YYYY
Please list information for educational institutions attended.
Bachelor's Degree:
--None--
None
BA
BFA
BS
Bachelor's State:
--None--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Bachelor's Institution:
Bachelor's Year Earned:
YYYY
Bachelor's Major:
Graduate Degree:
--select--
None
EdD
JD
LLM
MA
MBA
MD
MEd
MFA
MPA
MPH
MS
MSW
MUP
PhD
Graduate State:
--select--
None
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Graduate Institution:
Graduate Year Earned:
YYYY
Graduate Major:
Please prepare your ESSAY responses in advance of completing and submitting this application.
Essay One (300 word limit):
a) What has motivated you to apply for Leading Educators?
b) What do you want to achieve by participating in the Fellowship?
Competencies Assessed: Student Focused, Educational Equity, Constant Learning
Essay Two (300 word limit):
Describe a project you have led that has impacted student achievement . Please include how you worked with others to ensure the success of the project.
Competencies Assessed: Results Orientation, Communication and Influence
Essay Three (300 word limit):
Describe a time when you have used your understanding of others in order to build an effective
working relationship within your team or the wider school.
Competencies Assessed: Relationship Building, Belief in Potential
Resume*:
To submit your resume successfully, limit its length to no more than two pages. Please copy your
resume from a Word or Rich Text document and paste it into the text box below. (Any special formatting such as bold,
italicized or underlined text may not transfer. Do not include a curriculum vitae or cover letter.)
*Your resume must include all professional experiences (including dates of employment,
location, name of organization, your title/position, and your key roles and responsibilities).
Resume Comments:
Please comment on the experiences in your resume and highlight any accomplishments that you believe make you well suited to the Leading Educators Fellowship. (150 word limit)
References:
Please provide two current references in the fields below.
Reference One
Name:
Phone:
Email:
Reference Two
Name:
Phone:
Email:
Referral Source:
Please share how you heard about us, or name the individual who referred you to the program.
Referral Source Email:
Please share the email of your referral source if appropriate.
Recommend a Peer or Colleague:
Please share the name and email address of an excellent candidate you recommend for the
Leading Educators Fellowship. If you have additional nominees, please use our Get Involved
form and select Peer nominating an outstanding teacher-leader for the Fellowship as your
Primary Interest.
Nominee First Name:
Nominee Last Name:
Nominee Email:
Previously Applied:
Please check this box if you have previously applied for the Leading Educators Fellowship in any region.
SIGNATURE:
This application is my own work and is accurate and complete to the best of my knowledge.
I understand that misrepresenting myself by either withholding or falsifying documents is grounds for denial or revocation of admission.
I understand that this application is for the two-year Leading Educators Fellowship, for participation in Cohort 2014 (academic years 2012-2014).
I have read the above statement and agree with all parts.
Upon Clicking Submit:
Please confirm you have completed all required fields before clicking Submit.
You will be taken to a Thank You screen and receive an email confirming receipt of this application.
Leading Educators is committed to a policy of equal treatment and opportunity in
every aspect of its relations with its applicants, fellows, and staff members, without regard to race, color, ethnicity, religion,
gender, sexual orientation, national origin, disability, age, marital status, military status, pregnancy, or parenthood.