Series 601.2.2P - Application to Serve on the Curriculum and Instruction Advisory Council

 

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.

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Name                                                                                                                             

Home Address                                                                                                                 

                          ^{street                                   city                                             zip}

                                                                                                                                        

^{daytime phone                                                 evening phone}

Email                                                                                                                             

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