Teacher in Residence Program Application

Personal Data
Name Name * First Last
Preferred Name
Gender *

Gender Male Female Non Binary
Date of birth Date of birth * / MM / DD YYYY
Email *
Home/Cell Home/Cell * - ### - ### ####
Daytime Phone Daytime Phone * - ### - ### ####
Please select your preferred school district: *
Select your preferred content area. *
Resume Upload
Please upload your resume here:

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Unofficial Transcripts

Unofficial transcripts are due by the time you submit your application to ODU-TIR. That said, we encourage you to submit them before you apply so that you have feedback about what track options are available to you. Upload all transcripts from all institutions you have attended. (Please note, if selected for an interview, you must submit at least two OFFICIAL copies of all transcripts to the program director).
Upload Copy of Unofficial Transcript (PDF) *

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Upload Copy of Unofficial Transcript (PDF)

Attach Files
Upload Copy of Unofficial Transcript (PDF)

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Postal Address

Permanent Postal Address

Permanent *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Present Address Present Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Where did you FIRST hear about ODU-TIR? We are curious to learn about how you initially came across our program. This is not used for evaluation purposes. The more specific you can be the better we can gauge our recruitment efforts. Sometimes word of mouth is a powerful way that people hear about our program and it is as valid as the next. Please be candid. *
Academic Information
Where did you receive your undergraduate degree *
Undergraduate Major *
GPA *
Title of Degree (B.S. in Mathematics) *
Graduation Date Graduation Date * / MM / DD YYYY
Graduate School (if applicable)
Graduate Program (if applicable)
Title of Degree (M.S. in Mathematics)
Graduation Date Graduation Date / MM / DD YYYY
For Current ODU Students Only:

Are you part of another academic program?
If yes, which program?
Experience

Please list relevant work experience beginning with the most recent.
Current or Most Recent Position
Employer Contact Information (Address, Phone)
Supervisor Contact Information (Address, Phone)
Position
Date: From Date: From / MM / DD YYYY
To To / MM / DD YYYY
Last Annual Salary
Reason for Leaving
May we contact employer?
Responsibilities/Accomplishments
Previous Position Held
Employer Contact Information (Address, Phone)
Supervisor Contact Information (Address, Phone)
Position
Date: From Date: From / MM / DD YYYY
To To / MM / DD YYYY
Last Annual Salary
Reason for Leaving
May we contact employer?
Responsibilities/Accomplishments
Leadership, Volunteer and Internship Information:

1. What key leadership, volunteer and/or internship experiences have you had (if applicable)?
List Responsibilities
What key points did you learn?
2. What other key leadership, volunteer and/or internship experiences have you had (if applicable)?
List Responsibilities
What key points did you learn?
Student Teaching:

Have you student taught (a supervised student teaching practicum typically 9-credit hours or more at the college level) or will you have student taught by the time you would start the ODU TIR program?
Do you hold a provisional or professional teacher's license (or will you hold) by the start of this program?
Legal Information

Please note: You are not obligated to disclose sealed or expunged records.
Are you a US Citizen, US National or US legal permanent resident?
Have you ever been convicted of a felony or misdemeanor?
If yes, please elaborate:
Have you ever had any indicated finding of child abuse filed in your name?
If yes, please elaborate:
Does your name appear on any Sex Offender Database in any state or country?
Applicant's Acknowledgement & Agreement

By checking the box below, the candidate authorizes Old Dominion University at the Darden School of Education to conduct an investigation of whether a candidate has been convicted of any criminal or drug offenses.

I certify that the information given by me in this application is true in all respects, and I agree that if the information is found to be false in any way, it shall be considered sufficient cause for denial of admittance in the program. I authorize the use of any information in the application to verify my statement, and I authorize past employers, all references and any other person to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information.
*

Agree
I agree to all of the items above.

Please Sign *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Urban Background
Where did you attend high school? (Name, City & State)
Choose High School Type
If applicable, please list all Norfolk Public Schools you have attended
Have you been employed by the school district you are applying for?
If yes, please list positions held:
If you have worked with urban students, please describe in what capacity:
If you have worked with urban students, what have you learned? What are you curious to learn more about?
If you have not yet worked with urban students, what are you curious to know, and how will you acquire this critical hands on experience?
Teaching Preference
* Please note that if you should change your track choice that you will need to redress your responses in the Reflective Question section of the application. It is important that we understand your heart for your track as part of this overall work.

Reflection Questions:

1. What draws you to URBAN teaching? Please describe your professional, educational, and personal journey that led to this decision: *
2. Please describe a situation in your personal or professional life in which you faced a significant obstacle or struggle. What was your approach? What did you learn? What might you apply to your work as an urban teacher? *
3. What is it about the ODU-TIR program that has drawn your application? What makes you think you would be a good fit? *
4. What do you know about URBAN students? *
5. Why do you want to be a teacher specifically teaching in your field? Be mindful to address your track choice in this response. For example, why do you want to become a science teacher, special education teacher or a math teacher, etc.? *
Waiver Form
* Important Privacy Notice: Under the Family Educational Rights and Privacy Act of 194, students have access to their education record, including letters of recommendation. However, students may waive their right to see letters of recommendation, in which case the letters will be held in confidence. Do you waive your right to access letters of recommendation for your RTR Resident Application?

Informed Consent:

Teacher in Residence is funded by Virginia Department of Education. Part of our mission is to add to the body of knowledge about our understanding of residency programs including the recruitment and retention practices of candidates. To that end, we will be de-indentifying all applications as prescribed by current research best practices to study our applicant data. Your decoded data will not be tied to you as such will have no impact on your admission to or retention in the program.

As a TIR applicant, you acknowledge that you have read this statement and are aware that your data will be decoded and it will not affect or have any bearing on your admission or retention in the ODU Teacher in Residency Program.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Licensure Scores

Please upload all licensure scores in PDF form for the VCLA, Praxis Core Math (or ACT/SAT equivalent), and Praxis II for Middle School Science or Math. Although not required, you may also upload any other licensure scores that correspond to your candidacy (i.e Praxis II subjects tests). (Please note that all official licensure scores must be sent to the Office of Teacher Education Services at Old Dominion University.)
VCLA

Attach Files
Praxis II Middle School

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Praxis Core Mathematics

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Praxis II Content Knowledge (optional)

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Language Fluency
Are you fluent in a language other than English?
If so, what languages?
Professional References
Reference (1 of 3)

Name Reference (1 of 3)

Name * First Last
Organization *
Current Position *
Home Phone Home Phone * - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Work Phone Work Phone * - ### - ### ####
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Relationship
Years known
Reference (2 of 3)

Name Reference (2 of 3)

Name * First Last
Organization *
Current Position *
Home Phone Home Phone * - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Work Phone Work Phone * - ### - ### ####
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Relationship
Years known
Reference (3 of 3)

Name Reference (3 of 3)

Name * First Last
Organization *
Current Position *
Home Phone Home Phone * - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Work Phone Work Phone * - ### - ### ####
Mailing Address Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Relationship
Years known
ODU TIR Recognizes National Service

Please indicate if you are currently or have provided National Service:
Please indicate if you are currently or have provided National Service:

Please indicate if you are currently or have provided National Service: AmeriCorps The Peace Corps Teach for America Not Applicable
The following questions are to be answered only if you are currently or have provided national service:

Where did you serve (list geographic location and name of National Service Organization if you served more than one)?
What were your job titles (list one per line and not National Service Organization if you served more than one)?
What was the nature of your service (please note National Service Organization if you served more than one):
Anticipated Time Away
Do you anticipate having to take any days off from the program (other than for unanticipated events like an illness) for the upcoming year?
If so, how many days and for what reason?
Be sure to save your essay responses. After submitting the Teacher in Residence application, you must apply for official graduate admission to Old Dominion University at http://blue.odu.edu/admission/apply/

Teacher in Residence Program Application

Teacher in Residence Program Application

Personal Data

Resume Upload

Unofficial Transcripts

Academic Information

Experience

Legal Information

Applicant's Acknowledgement & Agreement

Urban Background

Teaching Preference

Waiver Form

Licensure Scores

Language Fluency

Professional References

ODU TIR Recognizes National Service

Anticipated Time Away

Be sure to save your essay responses. After submitting the Teacher in Residence application, you must apply for official graduate admission to Old Dominion University at http://blue.odu.edu/admission/apply/