Teacher Intake
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Current Status
English Honorific *
First Name *
Your answer
Last Name *
Your answer
Email Address *
**Please do not use your work email to avoid our emails from bring blocked.**
Your answer
Phone *
Your answer
Preferred Method of Contact *
Current School *
This information stays confidential. We use this information so not to match a student attending the same school where you teach.
Your answer
City Available to Teach #1 *
List the city or area.
Your answer
City Available to Teach #2
List the city or area.
Your answer
City Available to Teach #3
List the city or area.
Your answer
Subjects/Grades to Teach *
Required
Details and Specifics of Subjects; other Subjects/Services
Please also indicate if the class is honors, AP or IB.
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How did you hear about us?
Referred By
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This form was created inside of PACE Learning Center.