Save & Return

Create an account in order to save your answers and return to this form later.

Teacher Residency Program Application

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

San Juan College email address *

San Juan College ID Number *

Personal email address *

Which of the following best describe your race or ethnicity? (Check all that apply) *

Where did you hear about the SJC Residency Program? *

The Residency Program follows the SJC Alternative Licensure Program Guidelines. Which ALP Licensure Track are you pursuing? Please select only one option. *

Elementary (K-8)

Secondary (7-12)

Special Education (Elementary: K - 8)

Special Education (Secondary: 7 - 12)

Degree Awarded (i.e. B.S. Chemistry) *

Earned degree from which college or university? *

Month & year of degree earned (i.e. May 2005)? *

Each college/university attended:

+-

Do you have a contracted residency position? *

Which school district? What grade level? What subject? *