C-CUE Teacher Education Scholarship Application
PERSONAL INFORMATION
Full name *
Your answer
Phone number *
Your answer
Email address *
Your answer
If this is a joint application, list the names of the other teachers who would participate in this professional learning activity with you.
Your answer
Professional organization(s) you are a member of *
Your answer
SCHOOL INFORMATION
Name of school *
Your answer
School phone number *
Your answer
Principal or dIrect supervisor *
Your answer
Email address of principal or direct supervisor *
Your answer
Grade level(s) or subject(s) you teach *
Your answer
PROFESSIONAL LEARNING ACTIVITY
Write a detailed description of the professional learning activity you are applying for. Include a schedule or syllabus, topics to be covered, presenters, etc. *
Your answer
Why/How is this professional learning activity important to your growth as a teacher? *
Your answer
How will your participation in this activity benefit your students? *
Your answer
Outline all costs for this activity (registration fee, materials, mileage, lodging, substitute, etc.) *
Your answer
Does this professional learning activity assist you in earning a degree? *
ATTACHMENTS
In addition to this form, please send a letter ofsupport from your current principal or direct supervisor and a copy of your resume or CV to hpotoka@ccuechicago.org
PAYMENT and VERIFICATION
I understand that if I am the recipient of this scholarship, the funds will be paid to the school where I am employed and I may need to provide receipts to the school to receive the funds.

By submitting this application, I verify that the information provided is true and accurate.

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