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Kansas State Department of Education Teacher Leader Application
Section 1: Personal & School Information
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* Indicates required question
Name
*
Your answer
Primary Email
*
Your answer
Secondary Email (optional)
Your answer
School Phone Number (ex. 777-777-7777)
*
Your answer
Home/Cell Phone Number (ex. 777-777-7777)
*
Your answer
Home Address
*
Your answer
USD Number (numbers only)
*
Your answer
USD Name
*
Your answer
Administrator Name
*
Your answer
Administrator Email
*
Your answer
Superintendent Name
*
Your answer
Superintendent Email
*
Your answer
KSBOE District Map
Within what KSBOE district do you teach?
*
Your answer
Current Job Title
*
Your answer
Years of Experience in Education
*
0-5
5-10
10-15
15-20
More than 20
Professional Presentations (check all that apply)
*
I have presented locally.
I have presented outside my district.
I have presented at the national level.
I have not presented to an audience other than students and parents.
Required
What professional memberships or organizations do you find of value?
*
Your answer
What sources do you use to stay up-to-date on current education research?
*
Your answer
Regarding ASSESSMENTS, I am comfortable working with the following grade levels:
*
3
4
5
6
7
8
9-12
Required
Regarding STANDARDS, I am comfortable working with the following grade bands:
*
K-2
3-5
6-8
9-12
Required
Please select your primary discipline interest
ELA
HGSS
Mathematics
Science
English Learners
School Counseling
Health / PE
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