Credential Teacher Diversity

Student ID (optional)
First Name*
Last Name*
Street Address*
Address (cont.)
City*
State/Province*
Zip/Postal Code*
Home Phone
E-mail*

I intend to be a:*

Elementary School Teacher
Junior High School or High School Teacher

Check any of the following that apply to you:

I am currently receiving financial aid

I am currently in the Mini-Corp program

I am an active member of MECHA

I am an active member of Tomorrow's Teachers

I am currently a:*

I attend CSUCI:*

Part Time
Full Time

Enter the semester (fall or spring) and year you plan to begin a Credential Program in the space provided below.*

Year:*

I plan to enroll in a Credential Program at:*

CSUCI
Another University

Describe why your particular heritage and/or background is appropriate for you to be considered as a TDP scholar (read the Mission Statement for the Project to help guide your answer).*

I intend to provide teaching service in the following area(s):*

Multiple Subject
Special Education
Bilingual

I intend to provide teaching service in the following area(s):

Designated Low-Income School

Low-Performing School

Indicate if you have had any of the following positions or permits:

Student, not currently teaching

Substitute Teacher

Emergency Permit

Intern Credential

Pre-intern Credential

Teacher Instructional Aide

Check your ethnicity:*

Afro-American
American Indian
Asian
East Indian
Hispanic
Portuguese
Caucasian
Multi-ethnic
Other