Eligibility Pre-Screening Form

Country:

Street Address:

City:

State/Province:

Zip/Postal Code:

Country:

Facebook
UserName:

Twitter
UserName:

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 in a PC or Apple key in a Mac to select multiple programs or organizations.

If you are affiliated with an organization not listed above, please enter it here:

Program City:

Cohort Year of Interest:

Preferred School Type:

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:

In Progress Graduate Degree:

State:

Major:

Credit hours earned by June 2010:

Expected date of graduation:

Institution:

Institution, if not listed:

How many cumulative years of full-time work experience (including teaching) will you have by June 2010?

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 2010 to apply to the Charlotte or Washington, DC programs; 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, Milwaukee, New Orleans, New York City, or Prince George's County 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:

A public school (including charter schools) by June 2010?

A private/parochial school by June 2010?

Cumulative time as a substitute teacher:

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.

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 in a PC or Apple key in a Mac to select multiple items.

Please provide more information on the items selected above:

Of the options you chose above, how did you FIRST hear about New Leaders for New Schools? Note: the option you choose must also be represented in the above question.

Of all the sources you listed above, which one most influenced you to apply to New Leaders for New Schools? Note: the option you choose must also be represented in the above question.

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?

Have you ever been suspended from or required to withdraw from any school or college?

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 in 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. (500 words limit)

Please wait for the page to be submitted, otherwise the form will be submitted more than once and this may effect submission of the page.