Public: New Teacher Registration Please complete the profile form below. This information will auto-fill future forms for programs to make the application process faster and more consistent! Personal Information Honorific Ms.Mrs.Mr.Dr.Other Honorific (Optional) Name * Name First Name First Name Last Name Last Name Password * Show Password Hide Password cancel1 check1 Eight characters minimum cancel1 check1 One lowercase letter cancel1 check1 One uppercase letter cancel1 check1 One number cancel1 check1 One special character Confirm Password * Show Password Hide Password (Confirm Password) Teacher Status * I am currently a teacherI am a retired teacherI am a future educator NOTE: Future Educator status is for those currently or planning to enroll in college to work toward a career in education. Selecting this option will limit your access to programs to only include the Future Educator Scholarship. Personal Phone * Personal Email * Please do NOT use a school/district email here. School/District Email * Due to filtering, this will only be used if we can't reach you at your personal email. This is also used for verification purposes. Personal Address * Please do NOT use a school/district address here. Personal Address Line 2 Personal City * Personal State * AZAKALARCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Personal Zip * School/District Information NOTE: Please provide the information for the last school you at which you were a teacher. School, Center, or Facility Name * School Address * School Address Line 2 School City * City School State * AZAKALARCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY State School Zip * Zip Code School Location * Pima CountySanta Cruz CountyCochise CountyPinal County Type of School * PublicPrivateCharterOther Type of School Is your school part of a District? * Yes No District Name * Ajo USDAltar Valley ESDAmphitheater USDApache ESDBaboquivari USDBenson USDBisbee USDBowie USDCatalina Foothills USDCochise ESDCochise Technology DistrictContinental ESDDouglas USDElfrida ESDEmpire ESDFlowing Wells USDFt. Huachuca Accomodation SDMarana USDNaco ESDNogales USDPatagonia ESDPatagonia Union HSDPima Accommodation DistrictPima County JTEDRed Rock Elementary SDRedington ESDSahuarita USDSan Fernando ESDSan Simon USDSanta Cruz ESDSanta Cruz Valley USDSierra Vista Public SchoolsSonoita ESDSt. David USDSunnyside USDTanque Verde USDTombstone USDTucson USDVail USDWillcox USD Teaching Information NOTE: Please provide the following information based on your last teaching position. What year did you become a teacher? * Current Number of Students * (Approximate) Lifetime Number of Students * 1 - 100101 - 250251 - 500501 - 750750 - 1,0001,001 - 1,5001,501 - 2,0002,001 - 3,0003,001 - 4,0004,001 - 5,0005,001 - 6,0006,001 - 7,0007,001+ (Approximate) What year did you retire? * Grade(s) You Teach * PreK Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Subject(s) You Teach * Do you currently hold a valid AZ Teaching Certificate? * Yes No (Note: Some programs require a teaching certificate. Eligibility requirements can be found on each program's description page.) Teaching Certificate Drop a file here or click to upload Choose File Maximum file size: 134.22MB (A screenshot from the ADE Public Educator Lookup is acceptable) Date Teaching Certificate Expires * Automatic Program Enrollment Checking either of these fields will automatically create an application/request on your behalf for the applicable program(s). Please ensure all the information you've provided, including your personal shipping address, is accurate. Teacher Discount Card Request a Teacher Discount Card Video Interview (optional) Please check here if you would be willing to complete a video interview if selected (we'll come to you!) Demographics Information This information is for grant reporting only and does not impact the selection process for any programs. If you do not wish to disclose this information, you may choose “I prefer not to say” on any or all items below. Gender Identity * MaleFemaleNon-BinaryI prefer not to sayOther Gender Identity Hispanic/Latino Origin * Hispanic or LatinoNon-Hispanic or Non-LatinoI prefer not to say Race Designation(s) * Asian Black or African American Native American Native Hawaiian or Other Pacific Islander White Multi-Racial I prefer not to say Other Race(s)Other Race(s) Submit If you are human, leave this field blank.
