Teach NYC
 
Scholarships, Incentives, and Special Programs

Scholarship


Basic Information

         
First name   Last name   Middle Initial  
     
Social Security Number   Ethnicity (optional)   Date of Birth (optional)
   
Gender (optional)

Current Address

Address:
Address 2:
City: State: Zip:

Contact Information

Home Phone: ( ) -        
Work Phone: ( ) - Ext:        
Cell Phone: ( ) -        
E-mail:


Candidate's Acceptance into an Approved Program


Please choose one of the following:


  Discipline Name   Program Level
Bilingual School Psychology   Graduate
Bilingual Special Education   Graduate
Bilingual Speech Language Pathology and Audiology   Graduate
Bilingual Visually Impaired   Graduate
Monolingual Speech Language Pathology and Audiology   Graduate
Monolingual Visually Impaired   Graduate

Participating college/university to which you have been accepted as fully matriculated student.


Have you been accepted as a matriculated student?



If no, have you applied and are awaiting acceptance?




Language Proficiency

Are you proficient in a language other than English?


If yes, indicate the language:

Citizenship / Residency

Are you a U.S. Citizen?



If NO, are you a permanent resident?



If YES, have you filed a Declaration of Intention with the Immigration and Naturalization Service?




Recruitment Information

How did you first hear about the Scholarship Program?
If other please specify


Prior Incentive

Have you ever participated in any financial grant/award program administered by the New York City Department of Education's Division of Human Resources?



If yes, which program? If other please specify

Certification Information

Do you currently hold NYS certification?


If yes, what type of certification?


Educational Background

Indicate the highest degree you hold:

What is your cumulative undergraduate G.P.A?

If applicable, what is your cumulative graduate G.P.A.?


List the two most recent colleges / universities that you have attended:

  School #1   School #2
University / College  
City & State  
Major  
Attendance
From
 
Attendance
To
 
Date Degree Awarded  


Employment Information

Have you ever worked for the New York City Public School System?



If yes, in what capacity (i.e., title/position and/or license area)?



Eligibility Verification

1. Have you ever convicted of any criminal offense (felony, misdemeanor or violation) in this state or elsewhere?



2. Are any criminal charges currently pending against you in this state or elsewhere?



3. Have you ever forfeited bail or bond following your appearance as a defendant in a criminal court action?



4. Has a Family Court ever rendered a finding indicating you have abused or neglected a child?



5. Have you ever had any professional certificate or license denied, revoked or suspended?



6. Have you ever been discharged or required to resign from any position for reasons other than a layoff due to reduction in the work force?



7a. Have charges ever been preferred against you by an employer?



7b. Were you found guilty of the charges?



8. Have you ever resigned as an alternative to facing charges or dismissal?



9. Have you been disqualified for employment for any civil service position?



10. Have you ever had a teaching license or certificate denied, revoked or suspended by the New York City Board of Examiners or the New York City Department of Education because of unsatisfactory service or criminal record?



11. Have you ever received an unsatisfactory rating in conjunction with any pedagogical employment?



12. Have you ever been discontinued from probationary service or denied tenure as a pedagogue?



13. Did you ever receive a discharge from military service which was issued under other than honorable circumstances?



If you answered YES for any of the above eligibility questions, please provide an explanation below:

 Warning

Pursuant to New York State law, a person who knowingly makes a false statement on an application is guilty of a Class E Felony.


 Important

To be considered for acceptance into the Scholarship Program, you must complete the online application and submit the following documentation within 10 business days from the date the application was filed:

  • College transcript(s) documenting the award of a Bachelor's Degree. (Transcripts must reflect degree earned, date earned and the cumulative G.P.A., student copies are acceptable).


  • Copies of all New York State or other state teaching certificates (including any bilingual extensions to the State certificate) you may hold, if applicable.


  • Proof of U.S. citizenship or permanent resident status. (Example: Birth Certificate, Passport, Alien Registration Card.)


  • A completed College Acceptance Form from a participating college/university to which you have been accepted unconditionally as a fully matriculated graduate student. (If you have applied to a graduate school and your acceptance is pending, please submit a written statement to that effect).


  • A non-refundable application fee of $30.00 in the form of a money order made payable to the New York City Department of Education. (Personal checks will not be accepted).


  • To be considered for acceptance into the Scholarship Program, you must complete the online application and submit all required documentation within 10 business days from the date the application was filed. Please mail documents to:

    New York City Department of Education
    Division of Human Resources
    Office of HR School Support
    Scholarship and Incentive Programs
    65 Court Street, Room 508
    Brooklyn, N.Y. 11201

    Attention: Scholarship Program

    Incomplete applications will not be considered.


    I have read and understand the fact sheet for the above discipline area for which I am filing this application. To the best of my knowledge and belief, I meet the Scholarship Program's eligibility requirements in this area. I hereby certify that my statements contained herein, and in any explanatory enclosures are, to the best of my knowledge and belief, true and correct. I understand that any incomplete information or documentation will automatically remove my application from consideration and any omission and/or misstatement of material facts may cause me to be denied from this scholarship or terminated from receipt of said scholarship, and be incorporated in my record in connection with any future application, and may be referred for prosecution to the Office of the District Attorney.

    SERVICE OBLIGATION: Participants shall serve as New York State certified teacher/clinician in the area for which the Scholarship is provided for two (2) years for every year the Scholarship is awarded or any part thereof. Example: The Scholarship is awarded for one and a half years; the participant will owe for (4) years of service.

    Digital Signature
    Type Full name
    Date




    It is the policy of the New York City Department of Education not to discriminate on the basis of race, color, creed, national origin, age, handicapping condition, marital status, sexual orientation or gender in its education programs, activities and employment policies, and to maintain an environment free of sexual harassment, as required by law.