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COVID Learning Support Initiative
Questionnaire
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* Indicates required question
Email
*
Your email
Full Name (Last, First)
*
Your answer
Age
*
Your answer
Phone Number / E-mail
*
Your answer
Zip Code(s) where you have lived or taught for more than 1 year (3 or less total)
*
Your answer
I’m interested in committing as virtual support to students and teachers for:
*
at least 5 months.
at least 10 months.
On a weekly basis depending on availability (ONLY available to those interested in offering Tech Support / Administrative Tasks / Social + Emotional / Other)
I am willing to work as an Assistant Teacher:
*
As a Volunteer.
For Credit (School, CTE, other).
Any Compensation that can reasonably be offered.
A Set Hourly Rate (Funding is not yet secured, but is being pursued. If/When received there will be a set national sliding scale established. Note, however, funding may ultimately be limited.)
My prior experience was primarily in:
*
Choose
Public School
Private School
Charter School
After School
Other
N/A
I have personally attained the following level of education: (you need only check the highest level completed.)
*
Choose
Received a GED
Graduated High School
Graduated Undergraduate School
Graduated Graduate School
Other
I am currently a student working on my next degree. (also check whatever degree has been completed.)
My total aggregate experience working with kids from K-12th grade is:
More than 10 years.
Between 5-10 years.
Between 2-5 years.
Less then 2 years.
N/A
Clear selection
I have prior experience as a (check all that apply):
*
Teacher
Teacher’s Assistant
Administrator
Parent
Social Worker
IT / Tech Support
N/A
Required
I have experience as a Classroom Teacher for:
10 or more years.
2-10 years.
N/A
Clear selection
I have experience as a Teacher's Assistant for:
10 or more years.
2-10 years.
N/A
Clear selection
Do you have any experience working with students who have Individualized Educational Plans (IEP's) or educational accommodations?
Yes
No
Clear selection
If you answered YES above, please eloborate:
Your answer
I have experience as an Administrator for:
10 or more years.
2-10 years.
N/A
Clear selection
I have experience as a Social Worker for:
10 or more years.
2-10 years.
N/A
Clear selection
I have experience as IT / Tech Support for:
10 or more years.
2-10 years.
N/A
Clear selection
I have taught K-12 students for one year or more (check all that apply):
*
Reading
Math
Social Studies
Music
Language
Physical Education
Science
N/A
Other:
Required
I have experience working with students for one year or more that were considered (check all that apply):
Special Needs
ESL
N/A
Other:
Ideally, I would like to focus on...(Regardless of experience, what is your preference should we have that flexibility):
Your answer
Do you have your own computer?
*
Yes
No
I would get one
I would need to be provided with one
Other:
Do you have hi-speed internet?
*
Yes
No
I don’t know
In addition to English, I am also a fluent speaker of:
Your answer
Have you ever been fingerprinted in connection with working in a school?
*
Yes, within the last 2 years
Yes, more than 2 years ago
Never
I don't recall
Do you have any issues that may prevent you from participating? [i.e. - criminal history, immigration status, etc.] (If so, please give a brief explanation. If not, leave blank.)
Your answer
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