Date:
NAME:
(Last)
(First)
(M.I.)
Social Security #
MAILING ADDRESS:
(Street)
(City)
PHONE:(
)
(State)
// (
(Home)
E-mail Address:
(Work)
/
Birth Date
)
(Zip Code)
/
Birth Place
GENDER: Female ‘ Male ‘
Visa Type:
Citizenship-Country
ETHNIC BACKGROUND:
REFERENCES: (Please list 3 or more teachers, professors or other professionals who know of your potential)
NAME
TITLE
ADDRESS & ZIP CODE
1.
2.
3.
SEND COMPLETED APPLICATION TO: Science Teacher Careers, Dept. of Physics (NSB B334), Queens
College, Flushing, NY 11367
Phone Office: (718) 997-3398 or 3379 Mon, Tu & Th, From 11AM to 4PM in NSB Room B218.
How did you hear about this Program?
EDUCATION
COLLEGE ATTENDED
DATES
DEGREE
MAJOR
1.
2.
3.
High School Attended:
Are you now a student at Queens College? ‘ Working? ‘ Other ‘
Entering Queens College? Yes ‘
When?
Your present major?
Which Natural Sciences interest you?
Are you presently teaching? Yes ‘ No ‘ If so, at what school?
In what subjects?
WORK EXPERIENCE
Most recent employment first:
1. Present Employer & Dates of Employment
Address
Position/Responsibilities
2. Employer & Dates of Employment
Address
Position/Responsibilities
3. Employer & Dates of Employment
Address
Position/Responsibilities
GRADE PT.
AVERAGE
STC: PERSONAL ESSAY
To be Typewritten on Separate Pages
Please provide Full and Detailed answers to the following:
1)
Why do you want to teach science?
2)
Which personal traits will help you to become a good science teacher?
3)
What experiences in your life will help you become a good science teacher?
4)
Which sciences are you interested in teaching and why?
YOUR STC APPLICATION CHECK LIST:
Send To STC:
1. Application ‘
2. Personal Essay ‘
3. Transcript(s) ‘ only for colleges other than Queens College
Student copies of your transcripts are accepted with your STC application.
For your QC Admission: (if you are not presently a Queens College student), Obtain QC Admission
Applications Online (http://www.qc.edu/admissions/index.php) or at the QC Welcome Center in Jefferson
Hall Lobby. The QC Admissions procedure is different if you already hold a Bachelor’s degree.
* Admission to Queens College is a co-requisite for the STC Program.