Permanent Home Address___________________________________________
________________________________________________________________
Phone____________________________________
Email____________________________________
Elementary School Name____________________________________________
Principal's Name__________________________________________________
School Address___________________________________________________
________________________________________________________________
School Phone____________________________________
Email___________________________________________Number of Years Of Teaching Experience:____
At What Grade Levels?________
Approximate Percent of Students Of Color That You: Teach________% Reach ________%
Clear Credential(s) Held:____________________________________________
Other Professional and Relevant Work Experience:________________________
________________________________________________________________
Professional Organizations: (membership and offices held):
________________________________________________________________
Awards, Honors, Grants:____________________________________________
________________________________________________________________
Publications:______________________________________________________
________________________________________________________________
Community Involvement:____________________________________________
________________________________________________________________
On separate typed or word processed pages, please answer the following questions:
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In what ways do you encourage students of color to pursue high academic standards and career goals?
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What efforts do you take inside and outside the classroom to provide enrichment and support for students of color?
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What innovative methods do you use to teach mathematics, and to improve mathematics literacy among your students?
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To what professional organizations do you belong?
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What is your leadership involvement?
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How are you involved in local, regional, state, or national mathematics projects?
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Provide any other evidence of your dedication to mathematics literacy among your students.
Also enclose a support letter on school stationery signed by an administrator. Have the administrator address the ways in which you encourage students of color to pursue educational and career goals and mathematics literacy.
Completed applications and 4 collated copies should be postmarked no later than September 30 for the current year's conference. Mail completed applications to: