Certificate in Urban Teaching (CEUT) Teacher Application

Note: All fields are required unless noted.

First Name:

Last Name:

E-mail Address:

Home Address:
Street:

City:

State:

Zip:

Home Phone:

Race and Ethnicity:

Gender:
Female Male

School Name:

School Address:
School Street:

School City:

School State:

School Zip:

County:

District:

School Phone Number:

Fax Number:

Subjects Taught:

Grades Taught:

Number of years of teaching experience:
Number of years teaching in Minnesota:

Please respond to the following and limit your responses to 250 words.

Why are you interested in obtaining a Certificate in Urban Teaching?

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