COVID Learning Support Initiative
Questionnaire
Email address *
Full Name (Last, First) *
Age *
Phone Number / E-mail *
Zip Code(s) where you have lived or taught for more than 1 year (3 or less total) *
I’m interested in committing as virtual support to students and teachers for: *
I am willing to work as an Assistant Teacher: *
My prior experience was primarily in: *
I have personally attained the following level of education: (you need only check the highest level completed.) *
My total aggregate experience working with kids from K-12th grade is:
Clear selection
I have prior experience as a (check all that apply): *
Required
I have experience as a Classroom Teacher for:
Clear selection
I have experience as a Teacher's Assistant for:
Clear selection
Do you have any experience working with students who have Individualized Educational Plans (IEP's) or educational accommodations?
Clear selection
If you answered YES above, please eloborate:
I have experience as an Administrator for:
Clear selection
I have experience as a Social Worker for:
Clear selection
I have experience as IT / Tech Support for:
Clear selection
I have taught K-12 students for one year or more (check all that apply): *
Required
I have experience working with students for one year or more that were considered (check all that apply):
Ideally, I would like to focus on...(Regardless of experience, what is your preference should we have that flexibility):
Do you have your own computer? *
Do you have hi-speed internet? *
In addition to English, I am also a fluent speaker of:
Have you ever been fingerprinted in connection with working in a school? *
Do you have any issues that may prevent you from participating? [i.e. - criminal history, immigration status, etc.] (If so, please give a brief explanation. If not, leave blank.)
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