Online Application

Please complete the form, below. Fields marked with a red asterisk (*) are required. When you are done, click on the [Submit] button at the bottom of the page.

You will not be able to edit your application form after submitting it. You must complete the entire form in one sitting.

Your Primary Contact Information

Your Last Name: *

Your First Name: *

Your Gender: *

Male

Female

Your Home Street Address: *

Your Home City: *

Your Home State: *

Your Home Zip Code: *

Your Home Phone Number: *

Your Mobile Phone Number:

Your Email Address: *

Be sure to use an email address that you will check over the summer, and that can accept emails sent from outside of your school.

The Consortium in Which You Hope to Participate: *

Your School

Your District: *

Other District Name:

If you chose "Other" above, enter the name of your district here.

Your School's Name: *

Your School's Street Address: *

Your School's City: *

Your School's ZIP Code: *

Your Phone Number at School: *

Your Teaching Experience and Qualifications

Total Number of Years in Teaching: *

All Subjects and Grade Levels You Are Certified to Teach: *

Please list each subject/grade level on its own line.

Courses

Please provide information about up to 4 specific United States history and/or government courses that you are currently teaching.

Name of Course 1: *

Level of Course 1: *

Total # of Students You Teach in Course 1: *

Name of Course 2:

Level of Course 2:

Total # of Students You Teach in Course 2:

Name of Course 3:

Level of Course 3:

Total # of Students You Teach in Course 3:

Name of Course 4:

Level of Course 4:

Total # of Students You Teach in Course 4:

Your Educational Background and Training

Undergraduate Institution(s) You Attended: *

Please list each institution on its own line.

Undergraduate Majors and Minors: *

Please list each major and minor on its own line, and indicate whether it was a major or a minor.

Graduate Institution(s) You Attended or Are Attending:

Please list each institution on its own line. Leave blank if there are none.

Graduate Programs You Completed or are Completing:

List each program on its own line. Leave blank if you have not attended or are not attending graduate school