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WISEE (Workforce Innovation to Support Early Education) Application
Application is not complete until the final signature is completed at the end of this application.
OK
*
1.
Application Date
(Required.)
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2.
Please check which one reflects your
current
status:
High School Student
Early College
Early Childhood Teacher (Complete all Questions)
Neither of the above, but taking at least one 3 credit hour early childhood class
Other (please specify)
General Information
*
3.
Full Name
(Required.)
First Name
Middle Name
Last Name
What name do you prefer to be called?
*
4.
Address
(Required.)
Address
*
Address 2
City/Town
*
State/Province
*
ZIP/Postal Code
*
5.
Home Phone
*
6.
Business/Cell
(Required.)
*
7.
E-mail Address
(Required.)
*
8.
Date of Birth (MONTH/DAY/YEAR)
(Required.)
9.
County of Residence
10.
Name of your college if applicable
11.
Name of High School if currently enrolled
12.
Class(es) you are enrolled in if applicable
Class 1
Class 2
Class 3
Class 4
Class 5
13.
College Advisors Name or Internship Advisor:
14.
Area/s of interest
*
15.
Do you have reliable transportation?
(Required.)
Yes
No
*
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.)
I currently teach in an early childhood classroom
I may be considering a career in early childhood education
Neither
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)
*
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
*
18.
Have you been convicted of any criminal offense by a civilian court or by military authorities within the last seven years?
(Required.)
Yes
No
*
19.
Have you been adjudicated or held responsible as a juvenile offender of any criminal offense?
(Required.)
Yes
No
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.
21.
Anticipated degree:
22.
Anticipated date of graduation: (Month/Day/Year)
23.
Please Indicate the highest completed
High School Student
Early College Student
High School Diploma or GED
Community College/Technical School
Associate's Degree
Some college
Bachelor's Degree or Higher
Other (please specify)
Questions 23 & 24 are for Early Childhood Teachers Only
24.
Are you an active participant in T.E.A.CH.?
Yes
No
25.
Name of early childhood program where employed, if applicable:
For parent or guardian of applicants currently under 18 years of age:
26.
I have reviewed this application, and authorize my son/daughter/legal ward to apply to the WISEE program.
Signature
Date
Address
CERTIFICATION
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.
Signature
Date
Current Progress,
0 of 27 answered
