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1. Full Name

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2. Age

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3. Primary Phone Contact

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4. Primary Email Contact

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5. What school do you currently work at?

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6. What subjects are you certified to teach?

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7. What subject(s) and grade(s) will you (most likely) be teaching in the 2012-2013 school year?

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8. What grades and subjects have you previously taught?

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9. How long have you been employed at your current school?

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10. How long have you worked in the field of education? What positions have you held besides instructor if any?

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11. Please rate your INTEREST in incorporating the following into your classroom:

  Lots Some None
Web (blogs, Facebook, twitter, readers, youtube, skype, flickr, etc)
Graphics (Photoshop, Illustrator, etc)
Video (production, Movie-Maker, digital capturing, etc)
Audio (Apple GarageBand, sound recordings, etc.)

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12. What technology do you have available for use in your classroom, school, and district?
List every technology (e.g. long-distance conference rooms, Microsoft Office, digital cameras, document projectors, etc) available for your direct use in your classroom.

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13. What do you believe is the purpose of education today? What do you believe SHOULD be the purpose of education today? Please answer both questions.

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14. How can media and technology be used to support your students' critical thinking, creativity and collaboration? If you have a sample lesson which demonstrates your answer, please describe it below. For example, you might describe a lesson you have taught or would teach to demonstrate your response.

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15. Please describe your experiences with community-organizing or working with youth outside of the school setting, either currently or in the past. Please include a description of specific practices and methods of effective relationship-building that you have learned through this work. Be specific and list years and locations of the work.

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16. How did you hear about the Detroit Future Schools program?

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17. Will you be able to attend AMP Camp, the DFS mandatory network retreat the week of August 18th?

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