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.