TEACHER/ADMINISTRATOR APPLICATION COWAN COMMUNITY SCHOOL CORPORATION
9401 S. Nottingham St.,
Muncie, IN 47302
Phone: 765-289-4866 | Fax: 765-284-0315
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Digital Signature
****By selecting "I Accept" and typing your name, you are signing this document electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this document. By submitting this document using any device, means or action, you consent to the legally binding terms and conditions of this document. You further agree that your signature on this document (hereafter referred to as your "Digital Signature") is as valid as if you signed the document in writing.**** *
Name: *
Address *
City: *
State: *
Zip Code: *
Phone Number: *
Position for which you are applying: *
Grade/Subjects you are licensed to teacher: *
Administrative License(s) and Expiration date: *
Extra-curricular Activities capable and willing to supervise: *
Date you are available for assignment: *
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Personal Data
Experiences working with children: *
Training
Enter more than one if it applies
University 1
1. Name of college or university *
1. Dates Attended *
1. Year of Graduation *
1. Degree *
University 2
2. Name of college or university
2. Dates Attended
2. Year of Graduation
2. Degree
University 3
3. Name of college or university
3. Dates Attended
3. Year of Graduation
3. Degree
Teacher Preparation
Major Subject *
Minor Subject
Administrative Preparation
Major Subject *
Minor Subject
Experience
(list in chronological order schools in which you have taught and your administrative
experience: most recent experience first) List: District (name of school/district; Location
(City/Township/State); From/To; Number of Years; Grade/Subject Taught/Administrative
Level; Immediate Supervisor
1. *
2.
3.
List other work experience:
May we contact the employers listed above? *
INDIANA CERTIFICATION - (Teaching & Administrative)Please send/attach a copy of your license(s) to the email(s) at the bottom of this form. If you do not have a license, indicate when you made application.
OUT OF STATE CERTIFICATION (please circle one) *
RETIREMENT:
Are you (or have you been) a member of the Indiana State Teacher’s Retirement Fund (please circle one) *
If you circled YES, please indicate your membership number
REFERENCES
 (List at least three individuals) List: Name, Position, Address and Telephone.
1. *
2. *
3. *
SUMMARY OF NUMBERS OF YEARS TEACHING/ADMINISTRATIVE EXPERIENCES:
Please indicate a zero if you do not have any experience
Elementary *
Middle/Jr. High *
Senior High *
Number of years teaching:
Public Schools: *
Private Schools: *
Military Service:
Have you served on active duty in the United States Armed Forces? *
Dates of active duty:
From:
MM
/
DD
/
YYYY
To:
MM
/
DD
/
YYYY
Date of discharge:
MM
/
DD
/
YYYY
Type of discharge:
If employed and conditions prove satisfactory, would you plan to teach here at least three years? (please check one) *
Transcripts
Provide a copy of your transcripts or college work showing your degree(s), a copy of your license(s), and request your college to forward a set of credentials to the email(s) at the bottom of this form.

If you were required to pass a licensing exam such as Praxis or Pearson, please provide a
copy of your passing scores.

If you are selected for an interview, the building principal might require additional questions,
answers, or materials to aide in the selection process.
Signature of Applicant: *
Date: *
MM
/
DD
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YYYY
**Please be certain to complete the following section as an Application Addendum.
(To the best of our knowledge, this application complies with current law. The information requested is used only for school corporation administrative/statistical purposes.)

It is the policy of this Corporation that no candidate for a position in this Corporation shall be discriminated against on the basis of race, color, religion, national origin or citizenship status, creed or ancestry, age, gender, marital status, non-disqualifying disability, height, or other protected categories.

In accordance with Federal law, any person employed by this Corporation must provide evidence that s/he is eligible to work in the United States.
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