Applications

    SD-RET TEACHER BACKGROUND QUESTIONNAIRE

  1. Input your information
  2. Name* School
    Email* Date
    Subject(s) Teaching

  3. From what university where you awarded the teaching cerification?
  4. What do you hope to get out of this SD-RET experience?
  5. What is your gender?
  6. Male
    Female
  7. Which best describes your race?
  8. American Indian or Alaska Native
    Native Hawaiian or Other Pacific Islander
    Black or African American
    Asian
    White
  9. What is the highest level of education you have completed?
  10. High school diploma or GED
    Associate’s degree
    Bachelor’s degree
    At least one year of course work beyond a Bachelor’s degree but not a graduate degree Master’s degree
    Education specialist or professional diploma based on at least one year of course work past a Master’s degree level
    Doctorate
  11. What teacher are you?
  12. Mathematics teacher
    Science teacher

    THE FOLLOWING TWO QUESTIONS ARE FOR MATHEMATICS TEACHERS ONLY.

  13. Did you have a major, minor, or special emphasis in any of the following subjects as part of your undergraduate coursework?

  14. Yes, a major Yes, a minor or special emphasis No
    a. Mathematics education
    b. Mathematics
    c. Other mathematics-related subject such as statistics
    d. Elementary or secondary education

  15. Did you have a major, minor, or special emphasis in any of the following as part of your graduate coursework?

  16. Yes, a major Yes, a minor or special emphasis No
    a. Mathematics education
    b. Mathematics
    c. Other mathematics-related subject such as statistics
    d. Elementary or secondary education

    THE FOLLOWING TWO QUESTIONS ARE FOR SCIENCE TEACHERS ONLY

  17. Did you have a major, minor, or special emphasis in any of the following subjects as part of your undergraduate coursework?

  18. Yes, a major Yes, a minor or special emphasis No
    a. Biology or other life science
    b. Physics, chemistry, or other physical science
    c. Mathematics or mathematics education or engineering
    d. Elementary or secondary education

  19. Did you have a major, minor, or special emphasis in any of the following as part of your graduate coursework?

  20. Yes, a major Yes, a minor or special emphasis No
    a. Biology or other life science
    b. Physics, chemistry, or other physical science
    c. Mathematics or mathematics education or engineering
    d. Elementary or secondary education

  21. Counting this school year, how many years have you been a school teacher, including part-time teaching?

  22. YEARS
  23. Counting this school year, how many years have you taught in this general subject area, including part-time teaching?

  24. YEARS
  25. Counting this school year, how many years have you taught in your current school, including part-time teaching?

  26. YEARS

  27. In the state in which you teach, what type of teaching certification do you hold?
  28. Regular or standard state certificate or advanced professional certificate
    Probationary certificate (the initial certificate issued after satisfying all requirements except the completion of a probationary period)
    Provisional or other type given to persons who are still participating in what the state calls an “alternative certification program”
    Temporary certificate (requires some additional college coursework and/or student teaching before regular certification can be obtained)
    Emergency certificate or waiver (issued to persons with insufficient teacher preparation who must complete a regular certification program in order to continue teaching)
    Regular or full certification by an accrediting or certifying body other than the state
    I do not have any of the above certifications in this state
  29. In what content area(s) does the teaching certificate marked above allow you to teach in this state? MARK ALL THAT APPLY.

  30. EDUCATION
    Early childhood/Pre-K, general
    Elementary grades, general
    Secondary education
    Special education
    Middle grades, general
    Natural Science
    Science, general
    Bilogical/Life sciencesl
    Chemistry
    Earth Science
    Physical science
    Physics
    Other natural sciences

    ENGLISH AND LANGUAGE ARTS
    Communication
    Composition
    Journalism
    Language Arts
    Reading
    Speech
    English as a Second Language
    ESl/Bilingual Education
    SOCIAL SCIENCE
    Social studies, general
    Anthropology
    Geography
    Government/Civics
    History
    Native American studies
    Psychology
    Sociology
    Other Social sciences

    MATHEMATICS ABD COMPUTER SCIENCE
    Mathematics
    Computer Science
    OTHERS
    Vocational/Technical education
    Foriegn languages
    Health education
    Art or music
    Others (Please Specify)


  31. Have you taken the following test?
  32. Not taken Taken and Passed Taken and have not yet passed Taken and awaiting test results
    a. An exam for National Board for Professional Teaching Standards certification

  33. How well prepared are you in teaching students from different cultural backgrounds?
  34. Well prepared
    Moderately prepared
    Not well prepared
  35. What is the best way to contact you? MARK ALL THAT APPLY.

  36. Phone Text Call
    Email:
    Mail: provide your mailing address below



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