Associate Training Application

Date*

Full Name*

Gender Pronouns*

Which of the following groups do you identify with?* (Check as many as apply)
Black/African AmericanHispanic/LatinxAsianNative AmericanLGBTQ+Other

Street Address*

City*

State*

Zip*

Email*

What is your highest level of education?*

Are you currently working in a school setting? If yes, please list the school and district. If no, please describe the type of educational setting you are working in.*

Please provide demographic information about your school and school district. Include the number of students in your school and district, percentage of students of diverse ethnic backgrounds, and the percentage of students who receive free/reduced lunch.*

How did you hear about the Orton-Gillingham approach? Please describe your interest in Orton-Gillingham and why you are interested in completing the coursework and practicum.*

Describe how the Orton-Gillingham training and practicum will strengthen your professional practice and enhance your students' learning.*

Please describe your long-term goals in relation to Orton-Gillingham and your teaching practice.*

Please indicate* (Check all that apply)
I am self-funding my OG trainingI am seeking a scholarshipI am seeking a scholarship and would require it in order to attend the training and practicum

If I am selected as the recipient of this scholarship, I agree to have my photo and profile published in a future Orton-Gillingham Academy newsletter.*
[acceptance* acceptance-agree] I Agree

How did you learn about this scholarship opportunity?*

Please upload your resume and a headshot which may be published in a future OGA newsletter.*