Participant Cadre Data Entry Form

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Non-teaching Math Teacher Coaches (full or part-time). Non-teaching Science Teacher Coaches (full or part-time). Parapro
Please Return via FAX: 254-666-0823 or Email: MATH [email protected] SCIENCE [email protected]

TRC Cadre Entry Form

First Name

Middle

Primary Phone

Gender

F

Extn.

Last Name

Prior Name (if recently changed)

Email Primary

Ethnicity

M

Hispanic/Latino

Black or African American

American Indian or Alaska Native

White

Asian

Two or More Races

Region # School Name

Native Hawaiian/Other Paci

District Name

Project Name Project Type

Math

Member Type

Science

Mentor

Cadre

OPD

Job Description (choose one) Regular Core Content Teacher AP/IB High School Gifted and Talented Teacher Special Education Teacher Teachers of ELL Non-teaching Math Teacher Coaches (full or part-time) Non-teaching Science Teacher Coaches (full or part-time) Paraprofessional

Primary Professional Area (choose one) Elementary School Middle School High School Elementary Administration Middle School Administration High School Administration Other/NA

Select the Job Description In which you spend at least 50% or more of your time.

Select the Professional Category in which you spend at least 50% or more of your time.

Education/Degree (choose one)

Not a Classroom Teacher:

High BA/BS MA/MS PhD/EdD

Select only if you are Not a Classroom Teacher

Do you have an academic major in science or math?

Yes

Yes

TRC Cadre Data Entry Form

TRC Project Experience Years As of school year 2013-2014 If this is your 1st year of teaching please enter 1 above.

Were you certified through an alternate certification Program?

Yes

No

Will you be involved in an Immersion Classroom?

Teaching Experience Years

If Yes, which gradesor subject are involved? High School* Elem/MS Grade*

3 4 5

6 7 8

Biology Chemistry

Physics IPC

Algebra I Algebra II

Geometry

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Please Return via FAX: 254-666-0823 or Email: MATH [email protected] SCIENCE [email protected]

Grades Currently Taught (Can be multiple)

Pre-K Kindergarten 1st Grade 2nd Grade

9th Grade 10th Grade 11th Grade

6th Grade 7th Grade 8th Grade

12th Grade

3rd Grade 4th Grade 5th Grade Actual Grades of School Year 2013-2014

Subjects Taught (can be multiple) Science

Elementary Science

IPC

Physics

Middle School Science

Biology

AP/IB Science

Other

Chemistry

Math (can be multiple)

Elementary Math

Algebra I

Middle School Math

Algebra II

AP/IB Math

Geometry

Other

Calculus

TRC Cadre Data Entry Form

Math Models

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