Interest Form

1 - General Information

Contact

Application Id

Form Guid

Member Id

Full Name

Phone Number Label

Phone Number

Cell Phone Number

Secondary Phone Number (if applicable)

Email Address

Permanent Mailing Address

Permanent mailing address *

Street Address Line 1

Street Address Line 2

City

Zipcode

Current City of Residence (if different from your permanent mailing address)

Education

Undergraduate Degree

Bachelor of Arts (B.A.)

Bachelor of Sciences (B.S.)

Other

Undergraduate Degree Other

Undergraduate Institution

Undergraduate Major

Undergraduate Minor/Second Major (if applicable)

Cumulative Undergraduate GPA

Graduation date (or expected date of graduation)

Do you currently (or do you soon expect to) have a graduate degree as well?

Yes

Graduate Institution

Graduate Degree Field

Graduate Degree Awarded

Graduate Degree Graduation Date

Arizona Connection

How would you describe your connection to Arizona? (e.g. You grew up, currently live, or have family in Arizona, have always wanted to live in the west, etc.).

I plan to utilize the Arizona Teachers Academy funding to cover my tuition for the M.Ed. at NAU through AZTR and understand the requirements for eligibility which include: admission to NAU as an in-state or out-of-state student, enrollment in an NAU ATA eligible degree program such as the degree program(s) offered through the Arizona Teacher Residency, eligibility for FAFSA and have a current FAFSA on file with NAU’s Office of Scholarships and Financial Aid (OSFA), willingness to commit to the ATA teaching service commitment (for Arizona Teacher Residency participants, this will include two years of teaching in an Arizona public district, public charter, or Bureau of Indian Education school after you complete the two-year eligible degree program) *Please Note: Participation in the Arizona Teachers Academy at NAU is first-come, first-served for students who complete all eligibility requirements, up to the allowable funding provided by the state.