Date: 
 

Personal Information

Name:

SID#:

Date of Birth:
 

Local Mailing Address: 
 

City:

State:

Zip Code:

Local Telephone Number: 
 

Email Address: 
 

Permanent Mailing Address: 
 

City:

State:

Zip Code:

Permanent Telephone Number: 
 
 

Gender:Male  Female
 

Ethnicity:	American Indian	Caucasian/White
	African American	Hispanic/Latino
	Asian American	Native American/Pacific Islander
	Other (specify)

 

Citizenship:    U.S. Citizen Yes No
If no, specify country of citizenship or country of birth. 
 

Name and occupation of parents or guardians:

        1.  Name:         Occupation: 

        2.  Name:         Occupation: 
 

I have previously participated in the following programs (check all that apply):

Student Support Services
Talent Search
Upward Bound
Upward Bound Math/Science
 
 

Additional Information
 

Major:                     Expected Date of Graduation: 

Please list all academic awards or honors you have received.

Please list any additional awards or honors you have received.

 
 

Recommendations

Applicants are to submit two letters of reference (at least one from an academic source).  Recommendations can be completed online or you can obtain the Microsoft Word recommendation form.

Names of references:

        1.  Name:             Telephone #: 

        2.  Name:             Telephone #: 
 
 

Employment and Volunteer Experience

List your volunteer and employment experiences for the past 2 years (attach a separate sheet if needed):

1.  Job title: 
     Employer name:         Telephone #: 
     Hours per week: 

2.  Job title: 
     Employer name:         Telephone #: 
     Hours per week: 

3.  Job title: 
     Employer name:          Telephone #: 
     Hours per week: 

1.  Volunteer job title: 
     Placement name:         Telephone #: 
     Hours per week: 

2.  Volunteer job title: 
     Placement name:         Telephone #: 
     Hours per week: 

Are you interested and committed to teaching in a school in the State of Delaware?Yes No
 
 

Essay

Answers must be 10-20 typed lines (attach a separate sheet of paper if necessary).

1.  Describe your academic goals and immediate plans following graduation.

 
 

2.  Describe your career goals, including where you hope to be in 5 to 7 years after graduation.

 
 

3.  What contributions will you make to the DE-TRP Program?

 
 

Authorization

1.  I authorize the DE-TRP to obtain my academic and financial aid records, as well as other relevant
     information pertinent to my eligibility in the DE-TRP.  I understand I must qualify for admission into the program.

2.  I understand that I will receive scholarship support from the DE-TRP and that
     participation in the DE-TRP requires that I commit to teaching in a high need target school.
     The Program will assist me in securing a teaching position and I agree to accept that position.
     Should I not accept a position, I agree to reimburse the US Deptartment of Education, the
     program sponser, for all scholarship and financial support that I received during my program
     participation.

3.  I certify that all information submitted in this application is complete and accurate to the best of my
     knowledge.

Signature                                     Date 

Click here to go to the reference form after submitting your application.