Teacher Leadership Initiative Application

Demographic Information

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* 1. First Name

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* 2. Last Name

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* 3. School Name

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* 4. Current Teaching Assignment (Grade, Subject)

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* 5. Preferred Email Address

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* 6. Cell Phone Number

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* 7. T-Shirt Size

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* 8. Preferred Shipping Address (for books, supplies, etc)

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* 9. What is your race?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

Choose not to answer