ND UNITED NEW EDUCATOR CAMPAIGN: MEMBER INFORMATION FORM

Name*
First Last
Personal Email*
Enter Email Confirm Email
Work/school Email (optional)
Enter Email Confirm Email
Mobile Phone*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
School/Facility of Employment*
Position*
The position and/or grade level and/or area you are currently teaching at your current school/facility of employment.
Are you involved in and/or leading any extracurriculars at your school?
Extracurricular Role
How many years have you been teaching?*
Please include accumulative years; not only the years and/or time spent at your current school/facility of employment.
Please list your college/university degree(s)*
Degree College/University
What year did you start teaching?*
What is one food you "can't live without?"*
This is assuming you can have water, proteins, vitamins and everything else your body would need.
Where did you grow up/what town do you claim as your "hometown?"*
City State
What are some of your hobbies and/or interests?*
What is a vacation spot and/or place you would like to visit one day?*
What has been your favorite vacation spot and/or place you have visited?*
What is the best thing your school's cafeteria serves?*
If you were part of a food fight, what food would you want to be armed with?*
CAPTCHA

Extracurricular	Role

Degree	College/University