The Connie Belin & Jacqueline N. Blank Fellowship Program For Teacher Training In Gifted Education

Application Form

(Deadline: March 18, 2019)

First Name MI Last Name
School Name Administrator Name
Work Address 1
Work Address 2
City State Zip
Work Phone Work Email

Home Address 1
Home Address 2
Home City Home State Home Zip
Home Phone Home Email

Educational Degrees/certification
Institution Degree/Certification
Institution Degree/Certification
Institution Degree/Certification
Institution Degree/Certification

1. Brief listing of most relevant educational work experience.

2. Listing of courses completed in gifted education.
Course Year Institution
Course Year Institution
Course Year Institution
Course Year Institution
Course Year Institution
Course Year Institution

3. Briefly discuss any educational experiences in gifted education (e.g., workshops, conventions, work with a particular student, etc.

4. Briefly discuss any attempts you have made in your classroom to initiate teaching strategies or units that were particularly designed for the student(s) whom you considered gifted. Also, give an evaluation of the results.

5. What resources are available to you now in working with gifted students? Be sure to include names of people or organizations. What kind(s) of assistance have you received?

6. What do you believe you need in order to be a more effective teacher for gifted youngsters?

7. Briefly share something about yourself, as a teacher, which you think will be helpful for the director/instructor of the Fellowship Program to know.

Applications will not be considered without a statement of support from the appropriate administrator in your school; statements of support may be provided by following the link for Letter of Support.

In addition to the letter of support from your administrator, please provide names, addresses, phone numbers, email addresses, and professional relationships, of two people who are familiar with your teaching who could be contacted as references. Both these people should be able to provide information on why you should be considered for a fellowship.

Professional Reference 1
First Name MI Last Name
Address 1
Address 2
City State Zip
Phone Email
Professional Relationship

Professional Reference 2
First Name MI Last Name
Address 1
Address 2
City State Zip
Phone Email
Professional Relationship