Teach Plus Philadelphia Affinity Group Network Participant Interest Form

The Philadelphia Affinity Group Network seeks to cultivate authentic, inclusive, intersectional spaces for educators who identify as people of color. These affirming and supportive spaces, rooted in an asset-based understanding of diversity, will support educators in navigating and improving their school environments and will be connected to a larger network to build alliances and address systemic issues.

The affinity groups will meet at least monthly (starting in November 2024). Activities during affinity group meetings can include: building a supportive community through heart work & connection; providing professional ideas, support, advice & connection; identifying retention challenges in their districts; and, when feasible and safe, advocating to address those challenges. If you are interested in participating in the Philadelphia Affinity Group Network please take a moment to complete the interest form below.

Which of the following best describes you?

Please share the reason(s) you’re requesting to change your current affinity group. This will help us better understand your needs and identify the best group fit for you.

Contact Information

First Name

Last Name

Street Address

City

State

Zip

Preferred Email Address Type

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

Work/School Email

Confirm Email Address

Personal Email

Confirm Email Address

Alternate Email

Primary Phone

Mobile Phone

Personal Information

Ethnicity

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

Tribal Affiliation (Optional):

If "Ethnicity not listed" is selected, please specify

Gender Identity

If "Identity not listed" is selected, please specify

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

Teaching Information

What is your current position?

If "Other", please explain

Place of employment (e.g., Prince Hall Elementary)

Please write out the complete name.

City

State

Zip

Eligible PAGN participants may receive ACT 48 hours for attending network events and affinity group meetings; as such, please indicate your PPID in the box below. If you do not have a PPID number or are unsure, indicate "N/A" in the box below.

PPID Number

District/LEA of employment (e.g., School District of Philadelphia, a Philly-based charter). If you work for a charter, please identify the network or school where you work.

If "Other", please explain

What Philadelphia region best describes your school's location?

What grade(s) are you currently teaching or supporting?

Hold control (PC) or command (Mac) to select multiple grades

What is/are the primary subject(s) you are currently teaching or supporting?

Hold control (PC) or command (Mac) to select multiple subjects

Other Subject(s)

Years of work experience in education you have completed (including this school-year)

How did you hear about this opportunity?

Please specify how you heard.

Are you affiliated with the College of Education and Human Development at Temple University?

Yes; I attained an undergraduate degree (e.g., BSEd, etc.) at Temple University College of Education and Human Development;Yes; I attained a graduate degree (e.g., MSEd, MEd, PhD, etc.) at Temple University College of Education and Human Development;Yes; I am an alumnus of the Temple Teacher Residency program;Yes; I am a current student at Temple University College of Education and Human Development;Yes; I completed some coursework at the College of Education and Human Development at Temple University; however, I did not obtain a degree and I am no longer enrolled as a student;Yes; I completed some coursework at the College of Education and Human Development at Temple University; however, I did not obtain a degree and I am no longer enrolled as a student.No; I am not affiliated with College of Education and Human Development at Temple University.Select all that apply. To select multiple responses on a PC hold "Ctrl", on a Mac hold the Command key (next to the space bar).

In this section, you’ll provide information to help Teach Plus PA staff match you with an affinity group that best suits your needs.

If you already know the affinity group facilitator you would like to be paired with, please provide their name below.
If you are unsure which affinity group to join, you can share your preferences to help us find the best match for you.

Please select from the options listed below.

Please review the list of affinity group facilitators in the dropdown menu below and select your preferred facilitator.

Please select your preferred region for meeting with an affinity group.

Area of interest

Please select your preferred career status for group participants.

Do you have any additional comments or suggestions regarding affinity group configurations or the network as a whole? Please share your thoughts.

Contact Information