FELLOWSHIP APPLICATION

 

We are delighted you are taking this step to express your interest in pursuing a Leading Educators Fellowship. THIS IS A ONE-TIME SUBMISSION - you will NOT have the opportunity to return to this application at a later date. We recommend that you craft and save your responses in a Word document before pasting them into the fields below. This will also safeguard your data against possible interruptions, network connection failure, or browser freeze. (We recommend Firefox as a browser.)

 

Important Notes:

 

1) As email is our primary means of communication with applicants, please confirm you have entered your Preferred Email address correctly and ensure your account will accept email from the domains leadingeducators.org and nlns.org.

2) Please read detailed instructions in the SIGNATURE/Submit section at the bottom 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.

 

All fields required unless otherwise noted
Region of Interest: --None-- Kansas City New Orleans	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
In order to qualify for Leading Educators, you must serve in a teacher-leader role next year, or exhibit high leadership potential.
Current Title:	School Name Next Year:
School District:	County/Parish:
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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. Athletics 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.
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 (RTL, SPED, other) PD Resource/Head of Curriculum and Instruction Subject-matter teacher and department chair Other
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
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 form and the endorsement of your school leader are required.
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 1: In the United States today, there is a significant achievement gap that exists between students from wealthy backgrounds and students from lower income backgrounds. In your view, what are the most significant causes of the achievement gap? (350 word limit)
Essay 2: Given your answer to the previous question, what do you believe a teacher-leader can do to close the achievement gap? What steps might they take? What limitations might they face? (350 word limit)
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Strengths: Select your three greatest strengths as a teacher-leader from the list below. Assessment and Goal Setting Building Aligned Teams Change Leadership Communication and Influence Critical Thinking and Decision Making Cultural Proficiency Data Driven Instruction Differentiation and Interventions Discipline and Order Observation and Feedback Parent and Community Engagement Performance Management Presentation Skills Professional Learning Communities Project Management Relationship Building Self-Management and Care Situational Leadership Teaching Character Team Leadership	PD Needs: Select your three greatest professional development needs as a teacher-leader from the list below.. Assessment and Goal Setting Building Aligned Teams Change Leadership Communication and Influence Critical Thinking and Decision Making Cultural Proficiency Data Driven Instruction Differentiation and Interventions Discipline and Order Observation and Feedback Parent and Community Engagement Performance Management Presentation Skills Professional Learning Communities Project Management Relationship Building Self-Management and Care Situational Leadership Teaching Character Team Leadership
Resume: To submit your resume successfully, limit its length to no more than two pages. Please copy your resume from a Word 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).
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.