Teacher Leadership Academy - North Country

Teacher Leader Academy - North Country

Name

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Date of Birth*

Last 5 Numbers of SS#*

School District

New York State Certification Area and Number

How many years have you taught or provided related services?*

Why are you applying to the Aspiring Educational Leader Academy? What do you hope to gain from the experience?

What does leadership mean to you?

Discuss your leadership experiences. What are you involved with in a leadership capacity? How have your experiences shaped your understanding of leadership?

My direct supervisor (principal) is aware of my interest in this program and supports my attendance.*

Yes No

Supervisor Name

First Name

Last Name

Supervisor Email