2019 Education Summer Application 1. APPLICANT INFORMATION Question Title * 1. Applicant's First Name OK Question Title * 2. Applicant's Last Name OK Question Title * 3. Applicant's E-mail Address OK Question Title * 4. Applicant's Primary Telephone Number OK Question Title * 5. Will the applicant also be responsible for coordinating the Education Summer program at this local? Yes No OK Question Title * 6. Applicant's Position State Elected Leader Local Elected Leader Affiliate Staffer NEA Staffer OK Question Title * 7. Local Education Association Name OK Question Title * 8. State Education Association Name OK Question Title * 9. Local President's Name OK Question Title * 10. Local President's Email Address OK Question Title * 11. Are you a 1st year local president? Yes No OK Question Title * 12. UniServ Director Name OK Question Title * 13. UniServ Director Email Address OK Question Title * 14. UniServ Director Telephone Number OK Question Title * 15. Please provide the name of the individual who will be responsible for coordinating your Education Summer program. OK Question Title * 16. Please provide their email address OK Question Title * 17. Please provide their telephone number OK Question Title * 18. Have you notified your state affiliate's Executive Director of your local's potential participation in the 2019 Education Summer program? YES NO OK Question Title * 19. Has your Local President approved of your local's potential participation in the 2019 Education Summer program? YES NO OK NEXT
