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* 1. Name

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* 2. Preferred Email

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* 3. Mailing Address

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* 4. School Name (hyperlink to school website)

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* 5. School Type (select all that apply)

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* 6. Grade Level(s) and subjects taught during 2018-2019 School Year

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* 7. Number of years you’ve taught this grade/subject level

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* 8. Grade Level(s) and subject teaching next year

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* 9. Teaching experience

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* 10. Teacher Leadership Highlights

(Choose five examples from the last five years of your role as a teacher leader. These could include professional development delivered, presentations, awards, other institutes attended, etc.)

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* 11. Names of any team members applying with you (If none, please mark NA)

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* 12. How did you hear about us?

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* 13. How do you utilize or partner with museums and other educational or community institutions in your area?

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* 14. Why are you applying to this program?

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* 15. Age

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* 17. Race/Ethnicity (Select all that apply)

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* 18. Upload Administrator Sign-Off

PDF, DOCX, DOC file types only.
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No file chosen

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* 19. Upload Peer Letter of Recommendation

PDF, DOCX, DOC file types only.
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No file chosen

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* 20. Upload Community Letter of Recommendation

PDF, DOCX, DOC file types only.
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No file chosen

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* 21. Upload Project Proposal

PDF, DOCX, DOC file types only.
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No file chosen

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* 22. Link to video introducing yourself and discussing your role as an innovator in your teaching practice. If you are applying as a team, a single video will suffice. (YouTube video preferred)

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