1.

UB-TAH TEACHER REGISTRATION

* 1. Your First and Last Name

* 2. Name of the School were you curently teach:

* 3. Your E-Mail Adress

* 4. Your Work Phone Number

* 5. Your Gender:

* 6. Your Ethnicity

* 7. Year you were hired by the School District

* 8. Are you a certified educator?

* 9. According to NCLB, are you "Highly Qualified" to teach U.S. History or U.S. Government?

* 10. Grade level(s) you currently teach (check all that apply):

  1 2 3 4 5 6 7 8 9 10 11 12
Grade

* 11. For each subject(s) (in the rows below), check what column best fits what level you are currently teaching (check all that apply - you MUST check at least one option for each row):

  Not Currently Teaching Special Education Remedial General Honors Advanced (AP,CP,IB) Concurrent Enrollment (hs/college)
Tribal History
State History
U.S. History
World History
U.S. Government
Citizenship
Literature/English
Geography
Technology

* 12. What is your total number of years for each of the following:

* 13. Your highest level of education (check ONE):

Thank You Very Much!
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