Use for international # numbers.

Ex: 12/01/1990

The PEBC Teacher Residency is committed to diversity and intentionally seeks applicants from all racial and ethnic groups. The PEBC Teacher Residency does not discriminate on the basis of race, creed, color, religious beliefs, gender, sexual orientation, age, national origin, learning/physical disabilities, or veteran status. Additionally, this information will help PEBC identify any additional funding that may be available to you based on your identity and/or background.
Undergraduate Information 

Ex: 12/12/2016

Advanced Degree Information

Other Qualifications 

Language Skills

i.e., Can hold a conversation with parents, but not lead a classroom lesson
Additional Information

Conviction Information

Address Information

How did you hear about us?

Please attach the following documents:
Statement of Purpose   

·Why do you want to become a teacher?

· How will you use your previous experience to ensure high academic achievement for your students?

· Why are you interested in this particular program (i.e. residency model or mentor support) as a way to become an educator in an urban or rural environment?

Essay – Choose ONE of the following prompts and write a brief essay (250 – 700 words).

· Describe and reflect upon a time when you faced serious obstacles to success in a professional, academic, or community-related endeavor. What specifically did you do to confront those obstacles? Were you ultimately successful? How will this experience help prepare you for effective teaching in a school environment?

· Describe and reflect upon a significant experience you have had interacting with people who come from backgrounds different from your own (i.e. racially, ethnically, socio-economically, religiously, culturally, etc.) What did you learn from this experience? How will this experience help prepare you for effective teaching in a school environment?

Resume or Curriculum Vitae
Letters of Recommendation
 - please send the survey link, below, to two people who can speak to your strengths, particularly as relates to a career in education: