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Host Teacher Application

1. Last Name:

2. First Name:

3. School:

4. District:

Charlotte-Mecklenburg Schools, NC
Cherokee
Chester
Clover (York #2)
Fairfield
Fort Mill (York #4)
Lancaster
Rock Hill (york #3)
Union, SC
Union, NC
York (York #1)
Other: please list below

5. School District E-mail address:

6. Grade:

7. Subject:

Art
Business Education
Dance
Early Childhood
Elementary
English-secondary
Family/Consumer Sciences
Math-secondary
Middle level language arts
Middle level math
Middle level science
Middle level social studies
Modern languages
Music
Physical Education
Science-secondary
Social Studies-secondary
Special Education
Theater
Other: please list below

8. Concentration: (Example-choral, resource, Spanish, etc.)

9. Certification Area(s):

10. What is the highest degree you have earned? Please list your major/field of study for the option selected. (This information is used for accreditation records only.)

Bachelor's degree
Master's degree
Doctorate degree

11. List specific time frames of teaching as indicated below. (This information is used for accreditation records only.)

Year started teaching:
If any breaks in teaching, indicate the year(s):
Most recent year of teaching completed:

12. Have you successfully completed your formal evaluation process (or the equivalent in North Carolina)?

13. Gender (optional):

Female
Male
Prefer not to answer

14. Ethnicity (optional):

American Indian/Alaskan Native
Asian
Black/African-American
Hispanic/Latino
Native Hawaiian/ Other Pacific Islander
White/Caucasian
Prefer not to answer

15. Describe ways in which you plan for and meet the needs of diverse learners in your classroom.

16. Share your strengths in communicating and collaborating with others.

By clicking the "Submit" button, you certify that the principal of your school is aware of your application, can certify the information you submitted is correct, and supports you serving as a host teacher for Winthrop University.