LACC Haitian Summer Institute

K-12 Educator Grant

Application

Application Deadline: June 2

Submit to LACC, FIU-MMC Campus, DM 353, Miami, FL 33199

or fax it to (305) 348-3593

Call (305) 348-2894 for more information

PART A. Applicant’s Basic Data (Please print or type)

1. / Name (last, first, m.i.):
2. / Home Address:
3. / Home Phone:
4. / Education:
a. Highest Degree Earned
b. Institution

PART B. Applicant’s Employment Data

5. / Number of years in present position:
6. / Full Time: / Part Time:
7. / Position Title:
8. / Date of Employment:
9. / Name of Institution/School:
10. / Address:
11. / Telephone: / Fax:
12. / E-mail:
13. / Academic Level Taught (Please check the appropriate academic level)
K-5
6-8
9-12
Curriculum Specialist
Other
14. / Percentage of Haitian nationals enrolled at school:
15. / Immediate Supervisor:
16. / Position Title:
17. / Telephone Number:
18. / For both teaching and non-teaching positions, please provide weekly schedule for current year.
Subject(s) Taught
(Title w/ one line description)
or Curriculum-related responsibilities / No. of Teaching
Or Curriculum-
related Hours per week / Grade Level(s) / No. of Students Taught or Affected/ % of Haitian students in class
19. / Previous Employment (Begin with most recent up to last 10 years)
Name of Employer / Dates / Position Title / Full/Part
Time / Major Impact/
Contribution Made
20. / Academic Degrees and In-Service Training (begin with most recent). Please do not substitute with resume.
Name of Institution / Dates Attended / Degree/Training Field of Specialization
21. / Awards, Honors, Publication(s), Etc. and Membership in Professional, Education and Civic Organizations (Offices held, outreach efforts made, distinctions, etc.)
Name of Organization / Activity / Dates

PART C. Essays

22. / International understanding-Describe what your personal and professional experience has been with regard to other societies and cultures.
23. / Explain your need for this experience abroad and why you want to participate in the Haitian Summer Institute. Indicate why you require greater knowledge of Haiti. Include a discussion on what aspects of the Haitian society you are interested in learning about. You must demonstrate a direct connection between the institute and your current teaching and /or administrative responsibilities.
24. / Describe how you would incorporate the experience into your professional work to enhance international intercultural understanding. (Such as teaching, curriculum development, and other outreach activities).

LACC Haitian Summer Institute Page 2 of 6

K-12 Educator Grant

Application