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2023-24 Chicago Change Agent Application

Eligibility Requirements

I understand my Change Agent problem of practice will be tied to a SMART goal connected to changing a practice of teachers in my school that impacts student outcomes in an academic area. I understand my administrator and I will create this goal together and work together towards reaching it throughout the year.

YesNo

I understand that my project must involve me leading and working with other teachers at my school (which must serve a majority of low-income students in Chicago). Teams can vary in scope and size (it could be your grade level partner or your entire staff, but it can't just be you doing all of the work by yourself).

YesNo

I have reviewed this application and proposal with my administrator and received their approval to submit. My principal agrees to participate in a short electronic survey and a phone interview as part of the selection process. My principal agrees to attend (or send another administrator with access to data and decision-making) an initial training with me over the summer. I understand that I am not guaranteed a position as a teacher leader. By checking 'yes' below, I acknowledge that I understand the qualifications, responsibilities, and compensation of this role as a Change Agent Teacher Leader from June 2023 to June 2024.

YesNo

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My Principal's Contact Information:

Principal's First Name

Last Name

Principal's Email Address

Teacher Leader Personal Information

First Name

Last Name

Preferred Email Address Type

To ensure you receive Teach Plus communications promptly, we strongly recommend using a personal email address.

Work/School Email

Personal Email

Alternate Email Address

Primary Phone

Mobile Phone

Street Address

City

State

Zip

Gender Identity

If "Identity not listed" is selected, please specify

What pronouns do you use? For example: They/Them, She/Her, He/Him

Ethnicity

Select all that apply. To select multiple responses on a PC hold "Ctrl", on a Mac hold the Command key (next to space bar).

Tribal Affiliation (Optional):

If "Ethnicity not listed" is selected, please specify

Do you identify as a person of color?

(i.e., Black, Indigenous, Latino/a/x, Asian, Pacific Islander, and/or of other global majority race or ethnicity)

Would you like to receive the Teach Plus Newsletter?

Newsletter (monthly)

News Blast (weekly)

Illinois Newsletter

Teaching Information

Teaching Status

If "Other" Teaching Status, please explain

Name of the school where you currently teach

Please write out the complete name.

School Address

City where you currently teach

State

Zip

District

If your School District does not come up as an option when entering it, please type and select "Not Listed".

School Type

If "Other", please explain

If you teach in a CPS school, what network?

Are you a CPS opportunity school?

What grade(s) are you currently teaching?

Select all that apply. To select multiple responses on a PC hold "Ctrl", on a Mac hold the Command key (next to space bar)

What is the primary subject you are currently teaching?

Select all that apply. To select multiple responses on a PC hold "Ctrl", on a Mac hold the Command key (next to space bar)

Other (please explain)

Years of teaching experience you have completed (including this school-year)

Have you achieved National Board Certification?

Are you a member of your local or state teachers' union?

YesNoN/A

If yes, please enter union name here.

How did you hear about this opportunity?

Please specify how you heard.

Where did you receive the majority of your teacher training prior to entering the classroom?

Please Specify (Teacher Training Other)

Which of the following organizations are you affiliated with?

Select all that apply. To select multiple responses on a PC hold "Ctrl", on a Mac hold the Command key (next to space bar)

If "Other", please describe

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