| Cohort Application Form |
| |
|
| Please contact Margaret Hunter at 217-581-2919 for other options |
| Cohort of Interest:
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| Date to begin: |
(mm-dd-yy) |
| Name: |
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| Home Address:
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| Home Telephone: |
(xxx-xxx-xxxx)
|
| Cell Phone: |
(xxx-xxx-xxxx) |
| Home email: |
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| School & District
where employed: |
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| Which ROE: |
|
| Position Held: |
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| School
Telephone: |
(xxx-xxx-xxxx)
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| School email: |
|
| Years of Teaching
Experience: |
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| Locations: |
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| Years of Administrative
Experience: |
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| Locations: |
|
| Do you currently work in
the public schools? |
Yes No
|
| Career Goal in 5 years:
|
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| In 10 years: |
|
| Do you plan on becoming a
public school superintendent? |
Yes No
|
| If yes, |
Within the next
1 year, |
| |
Within the
next 3 years, |
| |
Uncertain |
| Haveyou previously applied
to participate in an EIU cohort and were turned down due to
lack of space? |
Yes No |
| Have you already started
your Specialist program in Ed Admin? |
Yes No |
| If yes, Where: |
|
| How many courses:
|
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| When: |
(mm-dd-yy) |
| If there are any
extenuating circumstances that you think we should be aware
of, you may list them here. |
|
| |
|
| ***Important: In order to
ensure your form is processed, please make sure to enter
correct information. You must press the
SUBMIT button for your responses to be
recorded. If you experience problems using this form please
contact Margaret Hunter at mmhunter@eiu.edu
or phone (217) 581-2919. |
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