FORM ASSEMBLY: Program Director Form

Program Director Form

Thank you for your continued interest in becoming a OneGoal Program Director! Please fill out the following information. If you have any questions at all, please feel free to contact:

Bay Area: Bradley Hill at bradley.hill@onegoalgraduation.org

Chicago: Jasmin Price at jasmin.price@onegoalgraduation.org

Houston: Raven Brooks at raven.brooks@onegoalgraduation.org
Massachusetts: Daniel Lopez at daniel.lopez@onegoalgraduation.org
Metro Atlanta: Nicole Plummer at nicole.plummer@onegoalgraduation.org

New York: Shawn Sadjatumwadee at shawn.sadj@onegoalgraduation.org

Prior to completing this form, you should have been nominated, if you have not been nominated or are receiving an error, please nominate yourself first using this form.

Region

Last Name

Legal First Name

This should be your legal first name

Preferred First Name

This is the name that you prefer new people you meet to call you. We'll use this to create your email address.

Primary Email Address

If you already have a OneGoal email address, please enter that here. If you do not have a OneGoal email please use the email address at which you have received emails from OneGoal about your nomination.

Alternate Email Address

If you do not have an alternate email address, or do not wish to share one, please enter the same email as above.

With what gender do you currently identify?

[Optional] If you chose 'prefer to self-describe', feel free to do so here:

What pronouns do you use?

[Optional] If you chose 'prefer to self-describe', feel free to do so here:

With what ethnic and racial groups do you identify?

For example, Chinese and Mexican American; Dominican; African American; Black and American Indian; etc.

As we work to analyze data to improve our program for all program directors, it is helpful to use a simplified set of race/ethnic groups. Which of the options below best represents how you identify?

Are you currently employed as a teacher?

YesNo

What is your current title?

What is your current role at your school?

What is the highest level of education you have completed?

Counting this school year, how many years have you been a school teacher, including part time teaching?

Counting this school year, how many years have you taught in your current school, including part time teaching?

Have you completed the Illinois Student Assistance Commission (ISAC) Financial Aid Certification Webinar Series and received a certificate of completion?

Please note that this is not a prerequisite for becoming a OneGoal Program Director.

What is the primary subject you teach?

If 'Other', please specify

Do you identify as a first-generation college student?

Mobile Phone

Mailing Street

Mailing State

Mailing Zip/Postal Code

Classroom Schedule

Part of the selection process includes a classroom observation. Please enter any details (days, times, notes, classes where prospective OneGoal fellows might be, etc.) that will help OneGoal staff schedule a classroom observation.

Short Response

Why are you interested in becoming a OneGoal Program Director?

Refereneces

Administrator Reference

First Name

Last Name

Admin Title

Admin Email Address

Admin Phone

Colleague Reference

First Name

Last Name

Collegue Title

Colleague Email Address

Colleague Phone

Student Reference

First Name

Last Name

Student Email Address

Student Phone

Please note that the form may take a few seconds to submit. You can email the Data Solutions Team at datasolutions@onegoalgraduation.org if you are having trouble submitting a form. Include a screenshot or copy and paste any error language if available. Thank you for your patience!

Contact Information