Socrates Teacher Partner Application

Required Fields*

Please complete the application below. We strongly suggest that you print this page first, put all information that may require preparation into a document on your hard drive (Word, Excel, etc) and then return to this page to begin your application. If you have any questions, please contact Jeremy Babendure (jbabendu@ucsd.edu)

Click the Browse Button to upload a 1 or 2-page (no more!) Curriculum Vitae or Resume. Supported upload file types include Microsoft Word (.doc), Word 2007 (.docx), Adobe Acrobat (.pdf), and Plain Text (.txt).

Upload Curriculum Vitae or Resume

Contact Information

*Last Name:

*First Name:

*Middle Inital:

*Mailing Address:

*City:

*Zip Code:

Home Phone:

*Cell Phone:

*Email:

School Information

School District:

School Name:

Room Number:

Contact Number at School:

School Email:

Educational Background

Highest Degree Completed:

Date of Completion

Major / Minor / Subject Area:

University / College:

Certification:

Total # of Years Teaching:

General Questions

1. What course(s) and grade levels are you currently teaching?

2. What course(s) and grade levels do you expect to teach next year?

3. If you are currently in an administrative position, please briefly describe you position and its duties/responsibilities.

4. Have you ever participated in ScienceBridge workshop or program? If so, please tell us the name of the program/workshop and the year of your most recent participation.

5. Please provide a 3-4 sentence biosketch based on your academic background, interests, accomplishments, and current roles. Please write this in the third person (i.e. - "Jordan Rose is a physiology teacher and soccer coach at ..."). Be sure to include some interesting details that will help us to get to know you.

6. Why are you interested in a ScienceBridge Teacher Fellowship? How will your participation in the Socrates Fellows Program benefit you, your students, your school, and/or others?

7. How will the Socrates Fellowship program benefit from your participation?

8. Describe your experiences working with others in curriculum development or other educational projects (i.e., what worked? what didn't? how did/would you change it next time?)

9. Any other information that might help us to choose you

The following questions ask about personal information. This information is voluntary, and refusal to provide it will not subject you to any adverse treatment. It will be kept confidential and will be used only in accordance with Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendment of 1972. ScienceBridge will use this information to track program trends.

Gender

Male
Female

Race:

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Other
Prefer Not to Say

Ethnicity:

Hispanic / Latino
Not Hispanic / Latino
Prefer Not to Answer