Thank you for your interest in the FIUteach program!

Please provide the following information so that we may keep you informed of the FIUteach opportunities, classes, and scholarships.  We will not share you information outside of the FIUteach team and you may opt out by sending an email to our Master Teacher, Nicole Cook (nicook@fiu.edu) or to fiuteach@fiu.edu
What is your first name?

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* 1. What is your first name?

What is your last name?

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* 2. What is your last name?

What is your Panther ID?

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* 3. What is your Panther ID?

At what email address would you like to be contacted?

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* 4. At what email address would you like to be contacted?

At what phone number would you like to be contacted?

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* 5. At what phone number would you like to be contacted?

With which racial group(s) do you identify? (For multi-racial, mark all that apply)

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* 6. With which racial group(s) do you identify? (For multi-racial, mark all that apply)

Are you Female or Male?

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* 7. Are you Female or Male?

What is your major?

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* 8. What is your major?

Would you like to be contacted with information about this program?

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* 9. Would you like to be contacted with information about this program?

How did you hear about FIUteach? (choose all that apply)

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* 10. How did you hear about FIUteach? (choose all that apply)

Is there anything else you’d like to share?

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* 11. Is there anything else you’d like to share?

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