Teachers Network: Teachers Network Leadership Institute: 2009

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Teachers Network Leadership Institute: 2009 - 2010 Application

First Name:
Last Name:

School Name:
School Address:
School City:
School State:	New York
School Zip:
School Phone:

Home Address:
Home City:
Home State:
Home Zip:
Cell:
Phone:
Email:

Experience
What subjects do you teach?:	Bilingual/ESL Early Childhood English/Language Arts FACS/Business Foreign Language General Elementary Math Related Services Science Social Studies Special Education Technology/Information Literacy Unified Arts
How many years have you been teaching?:
What was your preparation for becoming a teacher?:
How have you continued your professional development?:
Please list any professional organizations and/or networks of which you are a member.:
Please list your areas of interest in education and education policy.:

Commitments	Please check off all the commitments in the boxes provided:
	I have access to the necessary computer equipment to check my e-mail and participate online on a regular basis.
	I will attend full-day Saturday sessions once every month (September through June) as well as Teachers Network’s annual spring conference. I understand that these sessions provide opportunities to participate in dialogues with policymakers, discuss readings, and develop action research plans.
	I will participate in conducting TNLI Action Research and writing documentation.
	I will complete and be prepared to discuss the assigned readings related to education policymaking.
	I will work with Teachers Network to publish an article concerning my fellowship in a local paper.
	Only If Applicable, Please Check One or Both of the Boxes Below:
	I am a teacher leader who is interested in becoming a school administrator.
	I am a New York University Cooperating Teacher—and am interested in receiving graduate credit for my participation in TNLI.

Essay
Please write a short essay (approximately two typed double-spaced pages) describing an initiative in which you were an active participant that was designed to produce positive classroom or school change. Be specific about your role.: To upload your document: Type in the name of your document: Highlight the name. Select the link icon and upload your document.

Recommendations
Recommendation1: To upload your document: Type in the name of your document: Highlight the name. Select the link icon and upload your document.
Recommendation2: To upload your document: Type in the name of your document: Highlight the name. Select the link icon and upload your document.

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