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

* 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.

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

* 3. Contact Information

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

* 5. Education

* 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

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

* 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)

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

* 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)

* 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)