2020-2021 BJS TEP Application

Application for the Boulder Journey School Teacher Education Program

in Partnership with

University of Colorado Denver and Colorado Department of Education

Date of Application *

Month Day Year

Full Name *

First Name Middle Name Last Name

Email *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Current Residence Phone Number *

Area Code Phone Number

Current Work Phone Number *

Area Code Phone Number

Do you have a Social Security Number? *

If accepted to the Boulder Journey School Teacher Education Program (Boulder Journey School TEP) will you be able to provide verification of your legal right to work for any employer in the United States? *

How did you find out about this program? *

Have you previously applied to this program? *

Where are you interested in completing your practicum?

I am interested in completing my practicum at my current place of employment. You must currently be employed at this site, and the school must be local. I am interested in being placed at a practicum site offered by the Boulder Journey School TEP.

List the site where you hope to complete your practicum. You must currently be employed at this site.

Have you started a discussion with your supervisor around this possibility?

We partner with local schools in the Denver/Boulder who serve as placement sites within this program. Placements are determined by the Boulder Journey School TEP Representatives. Examples of past schools that we have partnered with are located on the Boulder Journey School TEP website. In addition to your current place of employment, please list additional factors that can help guide us in your placement process if completing your practicum at your current place of employment is not possible (geographic location, population served by school, educational approach, logistical considerations, etc.).

We partner with local schools in the Denver/Boulder who serve as placement sites within this program. Placements are determined by the Boulder Journey School TEP Representatives. Examples of past schools that we have partnered with are located on the Boulder Journey School TEP website. Please list additional factors that can help guide us in your placement process (geographic location, population served by school, educational approach, logistical considerations, etc.).

PRESENT OR MOST RECENT EMPLOYER

Name *

Employed From *

Month Day Year

Employed To *

Month Day Year

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Job Title *

Responsibilities *

Supervisor *

Phone Number *

Reason For Leaving *

FORMER EMPLOYER

Name

Employed From

Month Day Year

Employed To

Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Job Title

Responsibilities

Supervisor

Phone Number

Reason For Leaving

FORMER EMPLOYER

Name

Employed From

Month Day Year

Employed To

Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Job Title

Responsibilities

Supervisor

Phone Number

Reason For Leaving

Do you have additional Employer(s) to add?

Yes No

FORMER EMPLOYER

Name

Employed From

Month Day Year

Employed To

Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Job Title

Responsibilities

Supervisor

Phone Number

Reason For Leaving

FORMER EMPLOYER

Name

Employed From

Month Day Year

Employed To

Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Job Title

Responsibilities

Supervisor

Phone Number

Reason For Leaving

FORMER EMPLOYER

Name

Employed From

Month Day Year

Employed To

Month Day Year

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Job Title

Responsibilities

Supervisor

Phone Number

Reason For Leaving

Have you ever been dismissed from a job? *

Yes No

Describe the circumstances regarding your dismissal.

Have you ever been dismissed from an educational program? *

Yes No

Describe the circumstances regarding your dismissal.

Is there any additional information we should be aware of that if discovered while you were a member of the Boulder Journey School TEP would discredit the program? *

Yes No

Please provide the additional information.

Name of College or University where you received your Bachelor's Degree *

Dates Attended *

Date of Graduation *

Degree *

Major *

List any other degrees that you have earned.

List any additional Colleges or Universities that you have attended. Please note, you are required to submit two official transcripts for each College or University attended.

List any postgraduate courses or other schools attended (include dates).

List any honors you received.

List any additional educational, professional, and personal experiences.

State any additional information you feel may be helpful to us in considering your application.

Do you hold a current or expired Teaching License?

Yes No

You will be asked to sumbit a copy of this license at a later date. If your current or expired teaching license is not from Colorado, you will need to apply for a Colorado teaching license. You will receive support with this process.

From what state?

In what endorsement area(s)?

Have you started the application process through the Colorado Department of Education?

Yes No

Have you determined which pathway you will take to apply for your Alternative Teaching License?

Yes No

Please note: The pathways are listed on this worksheet from the Colorado Department of Education.

What is your pathway?

List two people whom we may contact for a professional reference. At least one professional reference must be a direct supervisor:

1.

Name *

Relationship *

Address *

Phone *

Email *

2.

Name *

Relationship *

Address *

Phone *

Email *

Please include the following with this application:

Two professional letters of recommendation

Would you like to submit letters of recommendation digitally?

Professional Letter of Recommendation 1

Professional Letter of Recommendation 2

Submit 2 professional letters of recommendation by email to jody.ogrodnick@boulderjourneyschool.com, or by mail to,

Boulder Journey School c/o Jody Ogrodnick
1919 Yarmouth Ave
Boulder, CO 80304

A digital copy of your resume *

A written essay, describing a few experiences and relationships in your background which you feel have been significant in your development as an individual entering the field of education (no more than two pages) *

Two official transcripts, from all colleges and universities attended, each in a sealed envelope, mailed to:

Boulder Journey School c/o Jody Ogrodnick
1919 Yarmouth Ave
Boulder, CO 80304

A $75.00 non-refundable application fee, paid by phone at 303-443-8909, or mailed to,

Boulder Journey School c/o Jody Ogrodnick
1919 Yarmouth Ave
Boulder, CO 80304

Do you have a coupon code?

If you have any additional documents that you would like to include in this application, please add them here.

Browse Files

Have you been convicted of a felony (including plea of guilty or no contest) within the last 5 years? *

Attach a written explanation. A conviction may not bar the application, depending on the circumstances.

I understand that the Boulder Journey School TEP includes a teaching practicum. By applying to this Program, I am stating that I am physically and mentally able (with or without reasonable accommodation) to perform the essential functions of a classroom teacher in an early childhood classroom. I understand that those functions include the ability to work safely and effectively in a fast-paced environment that requires both physical and mental stamina. I am also stating that I am physically and mentally able (with or without reasonable accommodation) to participate in international travel for the Reggio Emilia Study Group component of the Boulder Journey School Teacher Education Program.

I certify that the information given herein is true and complete to the best of my knowledge. I authorize the Boulder Journey School TEP to investigate any information, including my employment history, educational background, and record of criminal convictions that it believes is relevant to my application. My former employers, educational institutions, and personal references may provide information that they may have about me in response to inquiry from the Boulder Journey School TEP Representative. I authorize all of my prior employers to release any and all information regarding my employment to the Boulder Journey School TEP, and I release and hold harmless the Boulder Journey School TEP and all of my prior employers from any and all liability resulting from any such release of information. I understand that acceptance to the Boulder Journey School TEP is contingent upon obtaining reference information gained through the above-mentioned reference checks as well as upon the successful completion of a criminal history check.

I understand that false or misleading statements or omissions in the application process (including in my application or during any interview) may result in a refusal to accept my application, or discharge in the event of acceptance.

I understand that I shall be required to provide documentation establishing my legal authorization for employment within the first three days of the school year.

I understand the following:

The Boulder Journey School TEP is an Equal Opportunity Employer and does not discriminate against applicants or employees on the basis of race, religion, national origin, sex, age, disability, marital status, veteran status, sexual orientation, genetic information, or any other characteristic protected by law. The Boulder Journey School TEP complies with the law regarding reasonable accommodation for disabled individuals. Applicants requiring reasonable accommodation in order to participate in the interview process are requested to contact the Boulder Journey School TEP in order to arrange accommodation.

I authorize investigation of all statements contained in this application. In addition, I confirm that to the best of knowledge my name has not been placed on the Central Registry as a confirmed perpetrator of child abuse and I have never been convicted of child abuse, or unlawful sexual behavior.

I also authorize the Boulder Journey School TEP to share this application, including all of its components, with any or all of the practicum sites listed in this application as part of our placement process.

I also authorize Boulder Journey School TEP to share this application, including all of its components, with University of Colorado Denver as part of the application process.

I understand that employment with the practicum sites associated with the Boulder Journey School TEP is at will and may be terminated by me or the School at any time, with or without cause.

Signature

Today's Date *

Month Day Year

2020-2021 Boulder Journey School Teacher Education Program Application

PRACTICUM PLACEMENT INFORMATION:

EMPLOYMENT HISTORY

PRESENT OR MOST RECENT EMPLOYER

FORMER EMPLOYER

FORMER EMPLOYER

FORMER EMPLOYER

FORMER EMPLOYER

FORMER EMPLOYER

EDUCATION

TEACHING LICENSE INFORMATION

REFERENCES

APPLICANT’S ACKNOWLEDGEMENT