TeachUp Program Interest Form

The TeachUp Program Interest Form may be used to request participation in the program. Please fill in all the information and click the “Submit” button. You will receive a follow-up email or telephone call from a TeachUp team member to discuss options. If you do not hear from us within five business days, please call us at (505) 566-3044 or email TeachUp@sanjuancollege.edu.

*Completing this form does not guarantee acceptance and funding through the TeachUp program, nor does it count as registration/enrollment in San Juan College or WNMU. Students accepted in the TeachUp program must still register as a student.

Name *

Last Name *

Mailing Address (Street Address or PO Box) *

City *

State *

Zip Code *

Primary Email *

Secondary Email

Primary Phone Number *

Secondary Phone Number

Education Level? *

High School Graduate/GED (Have not attended college)

Do not have my AA Degree (I do have some college credits)

Have my AA Degree

If you already have an AA degree, what was your field of study?

Are you currently enrolled at San Juan College or Western New Mexico University? *

Yes, I am currently enrolled at San Juan College

Yes, I am currently enrolled at Western New Mexico University

No, I am not currently enrolled at either college

I am not sure

If you are currently enrolled at either SJC or WNMU what is your student ID number?

If you are currently enrolled at either SJC or WNMU have you already registered for classes? *

Yes, I have been registered

No, I have not registered

I am not sure

Which academic degree are you interested in pursuing? Please select only one option. *

Early Childhood Education (birth to grade 3)

Elementary Education (kindergarten to grade 6)

Elementary Special Education

Secondary Education (grades 6 to 12) what will be your primary Subject Area? Secondary Education (grades 6 to 12) what will be your primary Subject Area?

Do you have a contracted position in the field of education? *

Yes

No

If you are employed in the educational field, where do you work?

	Answers
What school district?	Answers
What School?	Answers
What grade level?	Answers
What subject?	Answers
What is your job/position?	Answers

Statement of intent: Briefly explain why you want to be a teacher and what experience you have working with young people. If you already work for a school district, include your position and number of years in the position. *

How did you hear about TeachUp? *

When submitting this survey, you confirm you are aware of the following conditions:

You must be a resident of the State of New Mexico.
This application confirms your intent to participate in the TeachUp program.

It does not guarantee your acceptance into the program.

If accepted into the TeachUp Program you must take a minimum of 6 credit hours per semester and maintain a GPA of 2.0 or higher.

You intend to obtain a bachelor's degree in the field of education and become a licensed teacher in the State of New Mexico.

If you do not already have an associate's degree, you intend to complete this through San Juan College.
After completing your associate's degree, you intend to continue your education and finish your bachelor's degree with Western New Mexico University.
If you already have an associate's degree, you intend to complete your bachelor's with WNMU.
You intend to complete all requirements through the New Mexico Public Education Department (NMPED) to become a licensed teacher in the State of New Mexico.

Do you confirm your intent to participate in TeachUp? *

Agree, please submit my registration. (Yes, I agree to the conditions listed above.)