Teacher Creativity Fellowship Program 2018

 

TEACHER CREATIVITY FELLOWSHIP PROGRAM
Personal Information Form

Project Title *

Your Legal Name
(as reported to IRS)
First Name: *
Middle Initial: *
Last Name: *
Street Address
or PO Box
*
City *
State *
ZIP code *
Home Telephone
(area code and number)
*
Primary Email
Home/Alternate Email
Date of Birth
(optional)
Number of Applicants
Names of Other Applicants
(if applicable)
Employing School Corporation
(if applicable)
Name of Employing School *
School Street Address *
School City *
School State *
School ZIP code *
Employing School Telephone Number *
Educational Background *
Length and Nature of Teaching Experience (begin with most current position):
Dates*

 (current)
              
              

School and Subject Area*




 Other Amount *
 Current Teaching Position*
Grade Level*
Subject Area*
 

Have you received a Teacher Creativity
Fellowship grant in the past?

 

*

 

If yes, in what year was it announced?

 

 

How did you hear about this program?

 

*

 

* indicates form field is required in order to complete registration.

 

Please print and submit this cover page with your proposal.

If you have specific questions about the program or application
procedure, you may contact Lilly Endowment via e-mail:
teachercreativity@lei.org
Copyright 2016, Lilly Endowment Inc.
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