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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
: Flow Tejada at
flow.tejada@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
Please select...
Bay Area
Chicago
Houston
Massachusetts
Metro Atlanta
New York
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?
Please select...
Man
Woman
Non-binary/Gender nonconforming
Prefer not to answer
Prefer to self-describe
[Optional] If you chose 'prefer to self-describe', feel free to do so here:
What pronouns do you use?
Please select...
She/her
He/him
They/them
Ze/zir
Prefer to self-describe
[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?
Please select...
American Indian or Native Alaskan
Black, African American, African, or African Caribbean
East Asian or Southeast Asian
Latinx, Latine, or Hispanic
Middle Eastern or North African
Multi-racial or Multi-ethnic
Native Hawaiian or Pacific Islander
South Asian
White
Prefer not to answer
Are you currently employed as a teacher?
Yes
No
What is your current title?
What is your current role at your school?
Please select...
Dean
Counselor
Principal
Assistant Principal
Other
What is the highest level of education you have completed?
Please select...
High school diploma or GED
Associate's degree
Bachelor's degree
At least one year of course work beyond a Bachelor's degree, but not yet a graduate degree
Master's degree
Doctorate
Counting this school year, how many years have you been a school teacher, including part time teaching?
Please select...
1
2
3
4
5-7
8-9
10+
Counting this school year, how many years have you taught in your current school, including part time teaching?
Please select...
1
2
3
4
5-7
8-9
10+
Have you completed the Illinois Student Assistance Commission (ISAC) Financial Aid Certification Webinar Series and received a certificate of completion?
Please select...
Yes
No
Please note that this is not a prerequisite for becoming a OneGoal Program Director.
What is the primary subject you teach?
Please select...
Art
English
Math
Science
Social Science
Special Education
Other
If 'Other', please specify
Do you identify as a first-generation college student?
Please select...
Yes
No
Prefer not to answer
Mobile Phone
Mailing Street
Mailing State
Please select...
Edit this text
AK
AL
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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 e
mail 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