2013 STARTALK for Teachers:
Bridges to Children, Languages & Community Through Advocacy
ARABIC, CHINESE, PERSIAN, TURKISH
Teacher Application Form
For problems with the application, please email jonesc@indiana.edu or call (812) 855-0447.
Personal Information
First Name
Middle Initial
Last Name
Birth Date (mm/dd/yyyy)
__________________________________________________________________________
Place of Birth _____________________________________
Gender:
Male ___
Female ___
Citizenship
Are you a U.S. citizen?
If not a U.S. citizen or are you a permanent resident of the U.S.?
Contact Information
Mailing Address- Street:
City:
State:
Yes ___
Yes ___
No ___
No ___
Zip:
Write “best” next to the best way to contact you, as time will be tight!
______________________________________________________________________________
Home Phone:
Work Phone:
______________________________________________________________________________
Cell Phone:
Best time to be reached:
______________________________________________________________________________
Email Address:
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Education
Graduate Credit: You will be eligible to receive 6 graduate credits or 4 undergraduate credits for
Bridges to Children Teacher Training Program at no cost to you (a $3,000 to $6,000 value).
Would you like to register for graduate credit?
Yes ___
No ___
Would you like to register for undergraduate credit?
Yes ___
No ___
Higher Education Degree(s):
Degree
Major
Institution
______________________________________________________________________________
Degree
Major
Institution
______________________________________________________________________________
Language and/or Education Courses Completed
(for level, please specify undergraduate, graduate, or other)
Title
Level
______________________________________________________________________________
Title
Level
______________________________________________________________________________
Title
Level
_____________________________________________________________________________
Teaching Experience
Are you currently a practicing teacher?
Yes ___
No ___
If yes, please provide the following information:
Current School
City
State
_________________
__________
Subject(s) taught:
______________________
Grade Level:
______________________________________________________________________________
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Language Teaching Experience
Language:
School:
Level
How long?
_______
________________
______
_______
Language
School
Level
How long?
_____________
________________
______
_______
Non-Language Teaching Experience
Language:
School:
Level:
How long?
_____________
________________
______
_______
Language
_____________
School
________________
Level
______
How long?
_______
Language Proficiency: Using the following language proficiency scale, indicate the number that
most closely describes your proficiency (please select one for each category):
1. No practical usable proficiency—a few insolated words and expressions
2. Able to read simple prose with difficulty, follow simple conversations, use the language
to get around, but not without assistance when exchanging ideas
3. Able to read non-technical materials and technical writing in one's field, understand
ordinary native speech, carry on an exchange of ideas though haltingly
4. Fluency, accuracy, and range adequate for all normal social and professional situations
5. Functionally equivalent to a well-educated native speaker
6. Native speaker proficiency
Arabic:
Listening____ Speaking___ Reading ___ Writing___
Turkish:
Listening___ Speaking___ Reading__
_____________: Listening___
Speaking___
Writing___
Reading__
Writing___
[add your language]
English: Listening___
Speaking___ Reading __
Writing ___
Indicate below how your language proficiency was acquired (e.g., "three semesters’ undergrad
study at Indiana University"; "married to an Arabic speaker "; "raised in Turkish-speaking
family"; include study abroad experience) Below:
APPLICATION ESSAY
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(send your essay with this application to jonesc@indiana.edu Please write your statement in
English no more than two double-spaced pages and email it to jonesc@indiana.edu
CLEARLY MARK YOUR EMAIL: Startalk/your language FOR EXAMPLE: Startalk/ Turkish
Your statement should describe the following (it is important to include all aspects):
1.
2.
3.
4.
Previous teaching experience for Arabic/Chinese/Persian/Turkish language
What are the most important qualities of a teacher of your language? (list at least three).
What are your key goals for attending this institute? (List at least 3 in concrete goals)
How might you handle possible challenges in the institute? :
a. keeping up with a heavy homework load of English readings and
b. working with a partner whose strong opinions differ greatly from your own
5. A concrete plan for how the Bridges to Children Teacher Program will help you achieve
your goal to implement a program in your community and teach young learners. If you
can, please name community a site in your area where you might teach.
Medical Release
If accepted to participate in the Indiana University Bridges to Children: Languages &
Community Advocacy Teacher Training Program, I hereby consent to being photographed by
representatives of Indiana University and STARTALK and to the use of photographs and videos
in all forms of media for advertising, publicity, and other promotional purposes by Indiana
University, STARTALK program. I consent to the use of my name and the name of my school. I
waive any right to inspect or approve the finished product, including written copy, wherein my
photographs appear and waive all claims for compensation for such use or for damages.
I agree to the terms of this media release.____ (check)
Commitment Pledge
If selected for the Bridges Arabic-Chinese-Turkish Pedagogy Institute, I agree to complete all
institute requirements. Pledge: I agree to provide the materials I develop in the institute for use
on the website. I furthermore agree to pursue the community-outreach language program
advocacy plan I create in this Bridges Institute in my home community after the close of the oncampus institute activities.
I agree to the terms of this commitment pledge. _____(check)
Name __________________________________________________________
A Suggestion: It is suggested that accepted applicants bring a laptop computer to the institute
with Arabic word-processing software already installed. Participants who do not own a laptop
should borrow or rent one for the duration of the institute.
Submit this application AND essay statement as an ATTACHMENT to:
Christi A. Jones
Center for Social Studies and International Education
jonesc@indiana.edu
1900 East Tenth Street, Room 1038
Bloomington, IN 47406-7
Tel: 812-855-0447
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Fax 812-855-0455