Eligibility Pre-Screening Form

Country:

Street Address:

City:

State/Province:

Zip/Postal Code:

Country:

Click here to become a friend of New Leaders for New Schools on Facebook!

Program City:

Cohort Year of Interest:

Preferred School Type:

NOTE: The Milwaukee program is not accepting applications for the 2011-2012 cohort year. For more information, please click here to contact the Milwaukee office directly.

Application Deadline:

Are you a US Citizen or Permanent Resident?

Do you have military experience?

Have you previously applied to New Leaders for New Schools?

Are you affiliated with any of the following programs or organizations?
Hold down the CTRL key (PC) or Apple key (Mac) to select multiple programs or organizations.

If you are a Teach for America Alumni, please select your corps year:

If you are affiliated with a program or organization not listed above, please enter it here:

Gender:

Ethnicity:

Ethnicity, if Other:

Date of Birth:

Person with disability:

Bachelor’s Degree:

State:

Institution:

Institution, if not listed:

Graduate Degree:

State:

Major:

Year earned:

Institution:

Institution, if not listed:

Additional Graduate Degree:

State:

Major:

Year earned:

Institution:

Institution, if not listed:

1) How many years of full-time classroom TEACHING experience will you have by June 2011 in:

A K-12 public school (including charter schools) by June 2011?

A K-12 private/parochial school by June 2011?

A state-accredited Pre-K School?

Cumulative time as a substitute teacher:

Total years of classroom teaching?

Note: Student teaching does NOT count toward the minimum teaching requirement and should not be included in any of the work experience questions.

Note: You must have 2 years of full-time K-12 teaching experience by June 2011 to apply to the Charlotte program; 2 years of full-time K-12 teaching experience by the relevant application deadline to apply to the Chicago program; 3 years of full-time K-12 teaching experience to apply to the Baltimore, Bay Area, Memphis, Greater New Orleans, New York City, Prince George's County, or Washington, DC programs; and 5 years of full-time K-12 teaching experience to apply to Newark (part of the New York City program).

Of your teaching experience, how many years of full-time K-12 classroom TEACHING experience will you have in:

Determining cumulative time as a substitute teacher: Substitute teaching can be used toward the minimum full-time teaching requirement in all of our program sites except Chicago. At most, substitute teaching can count for up to one year of full-time K-12 teaching experience ONLY if you spent a year as a full-time substitute in the same classroom with the same students.  Otherwise, your substitute teaching can count for, at most, 6 months toward your minimum teaching requirement.

Note: Some program sites may accept experience in a Pre-K school, though it MUST be state-accredited to qualify.

2) Of your other school-based employment experience (NOT including Teaching), how many years of full-time work experience will you have by June 2011 as a:

Principal?

Assistant Principal?

Guidance Counselor?

Case Worker or Social Worker:

Dean of Discipline:

Other full-time, school-based role:

If you entered Other above, please specify your role(s):

Total years of school-based employment experience (NOT including Teaching)?

Current Profession:

If your current profession is not listed above, please enter it here:

Additional experience - Company/Organization:

Is this an education organization or a non-education organization?

Industry:

How did you hear about New Leaders for New Schools? Select all that apply.
Hold down the CTRL key (PC) or Apple key (Mac) to select multiple sources.

Please provide more information on the source(s) selected above:

Of the source(s) you selected above, how did you FIRST hear about New Leaders for New Schools?Note: the option you choose must also be represented in your answer to the above question (See note below).

Of all the source(s) you selected above, which one MOST influenced you to apply to New Leaders for New Schools?Note: the option you choose must also be represented in your answer to the above question (See note below).

Did you attend an information session (in-person or by phone)?

Did the information session impact your decision to apply?

Have you ever been dismissed from a school or school district (where you were employed)?

Have you ever been suspended from or required to withdraw from any school or college (where you were studying)? ?

Have you ever been separated from a branch of the armed forces of the United States under conditions other than honorable?

Have you ever been convicted of a felony?

Have you ever been convicted of a sex or narcotic offense?

Did you ever have a teaching certificate revoked or suspended?

Have you ever been accused in a child abuse or neglect report?

Are you in default on either child support payments or a student loan?

Provide an explanation for any question above for which you answered “Yes”. If you have any legal documents which may aid in explaining circumstances, please be prepared to share them with the admissions office upon request. (500 words limit)

Please be patient and wait for the page to be submitted on the first click! Clicking “Submit” again will cause the form to be submitted more than once, which can cause problems with the submission of your information. For technical difficulties submitting this form, please contact us at apphelp@nlns.org or (866) 649-0701.