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FREE Emerging Media Adviser Workshop Application

 

1. Please provide the following contact information using a phone number and address we can contact you at outside of school:

Please provide the following contact information using a phone number and address we can contact you at outside of school:   Name:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Email Address:
Phone Number:

2. Please provide the following contact information for your school:

Please provide the following contact information for your school:   Company:
Address:
Address 2:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Phone Number:

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3. What is the student population at the high school where you teach?

What is the student population at the high school where you teach?

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4. Please provide information regarding the demographics at the high school where you teach:

Please provide information regarding the demographics at the high school where you teach:   Percent African American
Percent Asian- American
Percent Caucasian
Percent Hispanic
Percent Native American
Percent Other

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5. Please provide information about the percent of students receiving free and reduced lunch where you teach:

Please provide information about the percent of students receiving free and reduced lunch where you teach:   Percent free lunch
Percent reduced lunch

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6. Please indicate the grade levels taught at your school:

Please indicate the grade levels taught at your school:   K 1 2 3 4 5 6 7 8 9 10 11 12

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7. Is your school

Is your school   Public Private

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8. How many years have you taught (any subject)?

How many years have you taught (any subject)?

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9. How many years have you taught journalism or communications?

How many years have you taught journalism or communications?

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10. How many years have you advised student media?

How many years have you advised student media?