T4 Application
Personal Information
Name (Last, First, Middle) *
Your answer
Local Address (Street, City, State, Zip) *
Your answer
Email address *
Your answer
Cell Phone
Your answer
Home Phone
Your answer
How many course hours will you have successfully completed by the beginning of Spring 2018? *
Your answer
Major or planned major *
Your answer
Current GPA *
Your answer
Are you a citizen of the United States? *
If applying for the job shadow, in which field would you prefer to observe? *
Which of the following programs are you applying for? (select all that apply) *
Required
Where are you currently a student? *
How would you describe yourself? Check any that apply.
Reference's Name (Last, First) *
Your answer
All T4 applicants must provide a name for a faculty reference with contact information. Additionally, references for T4 Scholarship Applicants must fill out a recommendation form located on the T4 webpage.
Reference's Email *
Your answer
Reference's Phone Number *
Your answer
DEMOGRAPHICS
The T4 program requests but does not require the information in this section:
Gender
Birth Date (DD/MM/YYYY)
Your answer
At which school does your reference teach? *
Are you a first-generation college student?
PERSONAL STATEMENT
Write a short (200 - 500 word) personal statement describing your educational and career goals as you see them now. Be sure to express why you are interested in the T4 program. *
Your answer
CONDITIONAL AGREEMENT
I declare that all the information contained herein and provided is true, correct and complete. I also agree that if I am accepted as a T4 Program, I will abide by the rules of the job shadow opportunity, master teacher job shadow experience, and/or scholarship program.
I agree with the conditional statement provided above. *
Required
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