Pilot Program Application – Athens State University

Alabama Recruit and Retain African American Male Teacher
Candidate Pilot Program Application

Name (required)

Today's Date (required)

MAILING ADDRESS

Street (required)

City (required)

State (required)

Zip (required)

CONTACT INFORMATION

Email Address (required)

Email Type(required)

Phone Number (required)

Phone Type(required)

EDUCATION

High School Attended (required)

Graduation Year (required)

COLLEGE EXPERIENCE

Name of College Previously Attended? (required)

If Other

Number of Credit Hours

Degree Earned

200 WORD ESSAY

Why I Want to be a Classroom Teacher? (required)

LETTER OF RECOMMENDATION

My Letter of Recommendation (required)

File types accepted: .doc, .docx, .pdf, .rtf

PROGRAM REQUIREMENTS

I agree to have a Background Check completed
I have a GPA of 2.5 or higher
I Agree to Two Year Teaching Commitment in the state of Alabama
I will meet with a mentor upon acceptance to the University and Program
I will participate in a Leadership project upon acceptance to the University and Program
I have completed a FAFSA Form

I agree to complete the following Program Requirements (required)

How did you hear about this opportunity? (required)