4th Annual Institute for Teachers of Color Committed to Racial Justice
Application

4th Annual Institute for Teachers of Color Committed to Racial Justice
APPLICATION
San José State University
San José, California
June 25-27, 2014
Application Due: April 1, 2014

You must complete the entire application to be considered.

For questions or concerns, please refer our website:
http://www.instituteforteachersofcolor.org/contact.html

* 1. As part of our effort to document the struggles of teachers of color, and how the Institute is serving/could better serve participants, the organizers are collecting data from applicants. If disseminated publicly, any identifiable information will be removed. Your consent/non-consent to participate in this research will not impact the consideration of your application in any way.

I give consent for my application to be used as data for Institute related research.

I give consent

I do not give consent at this time

* 2. Have you attended the Institute before? (check all the apply)

Yes, in 2013

Yes, in 2012

Yes, in 2011

No, I have never attended

* 3. Contact Information

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

* 4. What is your race and/or ethnicity? (Can check more than one)

Asian American

Black or African-American

Latina/o

Native American

Native Hawaiian or other Pacific Islander

Other

Other (please specify)

* 5. Education

Undergraduate institution

Undergraduate degree and major

Undegraduate year of completion

Credential institution

Credential type

Credential year of completion

Additional graduate degrees

* 6. If you have you participated in an alternative certification program, please list the name of that program (i.e. Teach for America, Teach Tomorrow Oakland, Teaching Fellows).

* 7. Employment Information

School or institution

District

Position held

* 8. How many years of experience do you have working in K-12 schools?

Preservice teacher

First year teacher

2-5 years

5-10 years

10+

* 9. What is the percentage of free lunch eligibility of students at your school site?

* 10. What are the racial demographics of STUDENTS at your school site? (Approximations are acceptable)

Asian American and Pacific Islander

Black or African-American

Latina/o

Native American

White

* 11. What are the racial demographics of the TEACHERS at your school site? (Approximations are acceptable)

Asian American and Pacific Islander

Black or African-American

Latina/o

Native American

White

* 12. In what ways do you work (or wish you could work) for racial justice in K-12 schools? (Response should be between 250-500 words)

* 13. Describe the most significant barriers or challenges you are facing as a teacher of color who is committed to racial justice. (Response should be between 250-500 words)

* 14. Please explain what interests you in this Institute, sharing specific goals for your participation. (Response should be between 250-500 words)

* 15. Would you like to be considered for a scholarship? (Priority will be given to teachers who are not receiving any institutional funding)

Yes, full waiver of registration fees

Yes, partial waiver of registration fees

* 16. If you would like to be considered for a registration fee waiver, please describe why you need this scholarship. (Response should be 250 words or less)