July 5 – July 28, 2000
in cooperation with
EASTERN CONNECTICUT STATE UNIVERSITY
WILLIMANTIC, CONNECTICUT
For students who will be Juniors or Seniors in September, 2000
Application Deadline: May 26, 2000
Selection Announcements: Week of June 3, 2000
The decision of the judges is final. Late applications will be placed on a waiting list to
be considered on a space available basis.
Please type or print.
Name __________________________________________________________________
SS # __________________________________________________________________
Date __________________________________________________________________
Date of Birth __________________________________________________________________
Age ______ Ethnicity/Race ______ Gender
______ Present HS Grade ______
School Name __________________________________________________________________
School Street Address __________________________________________________________
City, State & Zip Code __________________________________________________________
Guidance Counselor’s Name _____________________________________
Area Code & Phone # School Fax _____________________________________
Parents’/Guardians’ Names _______________________________________________________
Home Street Address _______________________________________________________
City, State & Zip Code _______________________________________________________
Home Phone # Work Phone # _______________________________________________________
In case of emergency, notify: _______________________________________________________
Name _______________________________________________________
Relationship to you _______________________________________________________
Area Code & Phone # _______________________________________________________
School activities/organizations in which you participate:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
School Honors you have achieved:
____________________________________________________________________________________
____________________________________________________________________________________
Your After-School Obligations: (baby-sitting, job, etc.)
____________________________________________________________________________________
____________________________________________________________________________________
Civic and/or Religious Activities:
____________________________________________________________________________________
____________________________________________________________________________________
What subject(s) you do feel is your strongest?
____________________________________________________________________________________
____________________________________________________________________________________
What subject(s) you do feel is your weakest?
____________________________________________________________________________________
____________________________________________________________________________________
To complete application, include high school transcript, two letters of recommendation (at least one from your school) and the essay.
Student and parent/guardian signatures are required.
Student Signature __________________________ Parent/Guardian __________________________________
ESSAY:
In your own words, write why you desire to become a teacher. What do you have to offer that is unique and needed in today’s schools and the schools of the 21st century? Please attach to this application a typed or word-processed page essay.
Do not exceed two double spaced pages.
Hartford, CT 06106