Application is not complete until the final signature is completed at the end of this application. 


Question Title

1. Application Date (Required.)

Date

Question Title

2. Please check which one reflects your current status:

 General Information

Question Title

3. Full Name (Required.)

Question Title

4. Address (Required.)

Question Title

5. Home Phone

Question Title

6. Business/Cell (Required.)

Question Title

7. E-mail Address (Required.)

Question Title

8. Date of Birth (MONTH/DAY/YEAR) (Required.)

Question Title

9. County of Residence

Question Title

10. Name of your college if applicable

Question Title

11. Name of High School if currently enrolled

Question Title

12. Class(es) you are enrolled in if applicable

Question Title

13. College Advisors Name or Internship Advisor:

Question Title

14. Area/s of interest

Question Title

15. Do you have reliable transportation? (Required.)

Question Title

16. To be eligible for the WISEE program, you must be teaching in an early childhood classroom or may be considering a career in early childhood education. Please select one of the following: (Required.)

Personal Expression (Required)
(Please answer the following based on your work with young children or your personal experiences which include interactions with children in your family, church, or community)

Question Title

17. What experiences have you had working with children in your personal or professional life? (What have been some of the challenges? What was most valuable about your experience? What did you enjoy most or find most rewarding and how does this relate to your desire to earn a degree in early childhood education?) (Required.)

Criminal History

Question Title

18. Have you been convicted of any criminal offense by a civilian court or by military authorities within the last seven years?  (Required.)

Question Title

19. Have you been adjudicated or held responsible as a juvenile offender of any criminal offense? (Required.)

Question Title

20. If you answered "YES" to any of the above questions, please explain in the space below; ( Please list the location, charge, date, and punishment. Conviction of a crime will not necessarily disqualify you from serving. Each instance and action will be considered in relation to the position for which you are applying. However, any intentional misrepresentation or omission will disqualify you. The conviction or substantiation of child abuse, child neglect, a violent crime, or a sexual crime will disqualify you from participation. Do not include minor traffic violations.  

Question Title

21. Anticipated degree:

Question Title

22. Anticipated date of graduation: (Month/Day/Year)

Question Title

23. Please Indicate the highest completed

Questions 23 & 24 are for Early Childhood Teachers Only

Question Title

24. Are you an active participant in T.E.A.CH.? 

Question Title

25. Name of early childhood program where employed, if applicable:

For parent or guardian of applicants currently under 18 years of age:

Question Title

26. I have reviewed this application, and authorize my son/daughter/legal ward to apply to the WISEE program.

CERTIFICATION

Question Title

27. Your application must be certified with your signature at the end of this application. 

By filling out the signature line at the end of this application you are certifying that all of the statements made in this application are true, correct, and complete, to the best of my knowledge, and are made in good faith.  I understand that misinformation or omission of information could result in disqualification and/or termination from the WISEE program. 

If accepted, I agree to abide by the rules and policies of the WISEE program.  I understand that no representative of WISEE has any authority to enter into any agreement contrary to the rules and policies of Stokes Partnership for Children.

 

I understand that this application is not an employment contract.

0 of 27 answered
 

T