Series 601.2.2P - Application to Serve on the Curriculum and Instruction Advisory Council
Adopted: July 1993
Revised: April 2014
If you are interested in serving on the District 196 Curriculum and Instruction Advisory Council, please complete this application form and submit it to Independent School District 196, Teaching and Learning, 3455 153rd St. West, Rosemount, MN 55068-4946, by the publicized deadline.
Print or Type
Name
Home Address
street city zip
daytime phone evening phone
Occupation
Do you have children in school? Yes No
If yes, please specify each child’s school and grade:
School ___________________________________ Grade ___________
School ___________________________________ Grade ___________
School ___________________________________ Grade ___________
School ___________________________________ Grade ___________
Why are you interested in serving on the Curriculum and Instruction Advisory Council?
What current or past involvement have you had with programs, activities, committees, etc. at the school or district level in this or other school districts?
What do you want to accomplish as a Curriculum and Instruction Advisory Council member?
(Optional) What experiences have you had with diverse populations?
List the name, telephone numbers and relationship of two references:
1. Name
daytime phone evening phone
Relationship
2. Name
daytime phone evening phone
Relationship
How did you hear about the Curriculum and Instruction Advisory Council?
I understand that membership on the Curriculum and Instruction Advisory Council is voluntary, that I will be expected to attend at least four council meetings during the year and that meetings of curriculum committees, which I may wish to attend, are usually held during the day.
Signature Date
THANK YOU FOR YOUR INTEREST
Procedures/601.2.2P/4-2-14