Teacher Leadership Program Application

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Please note: Have all of your application materials on hand before you begin. Information entered into the form fields below will not be saved until the form is submitted. If you refresh your screen before submitting the completed form, all previously entered information will be deleted.

All fields marked with an * are required.

Enter Your Information

First Name*

Preferred First Name

Middle Name

Last Name*

Previous last names that might appear on your transcripts or credentials

Birthdate*

Sex *
Please indicate your sex assigned at birth, in accordance with selective service regulations. You will be able to indicate your gender identity once you have access to the CU Boulder student portal.

Social Security Number (optional)

Your SSN is used for select business processes, including federal and state reporting, issuing tuition statements for tax purposes and verifying your Selective Service registration, among other things. Personally identifiable information is secured and accessed only by school officials with a legitimate educational interest who have completed student data privacy training, per university policy and federal law.

Enter nine numbers only, no spaces or '-' dashes

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latino? (optional)

Yes

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member: (optional)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific

White

Email Address*

Phone Number

Mailing Address*

Country

Street

City

Region

Postal Code

US Armed Forces Status*
If you have no affiliation with the US Armed Forces, please select "No relationship".

What is your country of citizenship?*

Are you a U.S. Permanent Resident?*

Yes

Alien Registration Number

Alien Registration Issue Date

Country of birth*

City of birth*

Will you be completing your classes while on a valid visa? (Note: If you will be completing your degree from outside the United States, please select "No" and choose the visa type "99" below. If you are unsure of your visa or immigration status, please select "No" and choose the "OTH" visa type below.)

Yes

Specify the visa type you currently have or expect to obtain following the instructions below.

If you already have a US Visa, complete all fields below.
If you are completing CU online coursework from overseas, please choose "99 - Intl Student Not In US" as your visa type and leave the remaining fields blank.
If you are unsure of your visa type or immigration status, please choose "OTH - Other" as your visa type and leave the remaining fields blank.

Visa Type

Issue Date

Expiration Date

Program Selection

Our program focuses on practical skills for working teachers and involves applying lessons in a classroom or afterschool program. Are you currently an active educator with a fieldwork site that you visit regularly?*

Yes

STOP! If you are not an active teacher and have questions about the role fieldwork plays in this program, please contact us at teacherleadership@colorado.edu.

I am applying for:*

Master's Degree

Graduate Certificate

Please select your program:*

Cultivating Compassion and Dignity in Ourselves and Our Schools

Designing for Learning: Inquiry-Based Pedagogy for K-12 Educators

Inclusive and Special Education

Leading for Change in Science Assessment Practice

Teacher and Social and Emotional Learning

Teacher Leadership - MA

Teachers Leading Change

Teaching Culturally/Linguistically Diverse Students

Select the term you wish to start*

Note: International students may need to submit official scores from a test of English proficiency. Please refer to your program's admissions page for the minimum requirements. We will contact you if additional documentation is required.

The application deadline for this program has passed. Please select another term listed above or contact us about applying for a future term at teacherleadership@colorado.edu.

Where did you receive your undergraduate degree?*

School Code

Upload an unofficial transcript from the school that awarded your undergraduate degree below.*

Tell us why you want to pursue this degree in a 500-600 word statement: What interests you, excites you, makes you curious about this degree possibility and/or any of the particular certifications? What is your background in the field of education and where do you teach? What are your goals for utilizing the leadership skills you will garner from these certificates? How would you like to create change within your school or community?*

Type or copy and paste your statement in the text box below.

Tuition Classification

Tuition classification is governed by Colorado state law (CO Revised Statutes §23-7-101, et.seq.) and applies to all public institutions of higher education in Colorado. In-state tuition classification eligibility requires one year of Colorado domicile (legal residence). Exceptions to the domicile requirement are provided for specific populations as provided by law. Refer to the tuition classification website for further information about domicile exceptions and Colorado resident/nonresident regulations and requirements.

Do you believe you may qualify for in-state tuition?*

Yes

Will you be at least 23 years old by the first day of the term in which you are enrolling for classes?*

Yes, I will be at least 23 years old by the first day of the term.

No, I will not be at least 23 years old by the first day of the term.

Did you earn a Colorado high school equivalency or graduate from a Colorado high school?*

Yes

No, my diploma or equivalency was earned outside of Colorado

Do you have a Colorado driver's license or official Colorado state ID?*

Yes

Have you lived continuously (remained physically present) in Colorado for the past two years?*

Yes

Have you filed resident personal income taxes in Colorado for at least the past two consecutive years?*

Yes

Are you a U.S. citizen, U.S. permanent resident, or undocumented/DACA applicant?*

Yes

Dates of continuous physical presence in Colorado:

From:*

To:*

Dates of absence from Colorado of more than 30 days within the past year, if applicable:

From:

To:

Please describe the circumstances of any such absence.

Dates of employment in Colorado:

From:*

To:*

List the years for which personal resident Colorado income tax returns were filed:*

Are you registered to vote in the United States?*

Yes

State of Voter Registration*

Date of voter registration*

Have you operated a motor vehicle in the past two years in Colorado?*

Yes

Do you own, or have available for personal use, a motor vehicle?*

Yes

State of Vehicle Registration*

Date of current Colorado motor vehicle registration*

Is this a renewal of a previously issued vehicle registration?*

Yes

Do you have a current driver's license or state-issued ID?*

Yes

State of Driver's License*

Date of issue*

If Colorado, list driver's license or ID number*

Is this a renewal of a previously issued Colorado driver's license or ID?*

Yes

Do you own residential property in Colorado that is your primary residence?*

Yes

Date purchased*

Do you maintain a home in another state?*

Yes

Have you ever served in the United States military?*

Yes

List dates of service:

From:*

To:*

Dates stationed in Colorado, if any:

From:

To:

Have you paid in-state tuition in a state other than Colorado by claiming residence in that state during the past two years?*

Yes

If yes, list colleges at which you paid in-state tuition:

Provide any additional information regarding unusual circumstances you would like to have considered.

Did you enter a Colorado college or university immediately after completing high school (e.g. you graduated in May/June and enrolled at a Colorado institution in August of the same year)?*

Yes

Have you lived continuously (remained physically present) in Colorado and maintained a Colorado I.D. since you completed high school?*

Yes

Did you attend a Colorado high school for at least three complete years?*

Yes

Did you graduate from a Colorado public or private high school?*

Yes

Are you a U.S. citizen, U.S. permanent resident, or undocumented/DACA applicant?*

Yes

Because you will not be 23 by the first day of class of the term for which you are applying, you must provide parent or guardian information below. Your residency will be based upon your parent's domicile (residency).

Possible exceptions include emancipated minors, military, married applicants, etc. If you are under 23 and hope to qualify for in-state tuition classification based on your personal domicile, please see the Tuition Classification website to determine whether you should fill out the below information using your own information.

Name of parent/guardian:*

Dates of parental/guardian continuous physical presence in Colorado:

From:*

To:*

Dates of parental/guardian absences from Colorado of more than 30 days within the past year, if applicable:

From:

To:

Please describe the circumstances of any such absence.

Dates of parental/guardian employment in Colorado:

From:*

To:*

List the years for which parent/guardian personal resident Colorado income tax returns were filed:*

Is your parent/guardian registered to vote in the United States?*

Yes

State of parent/guardian voter registration:*

Date of parent/guardian voter registration:*

Has your parent/guardian operated a motor vehicle in the past two years in Colorado?*

Yes

Does your parent/guardian own, or have available for their personal use, a motor vehicle?*

Yes

State in which vehicle is registered:*

Date of current motor vehicle registration:*

Is this a renewal of a previously issued vehicle registration?*

Yes

Does your parent/guardian have a current driver's license or state-issued ID?*

Yes

State of Issue:*

Date of issue:*

If Colorado, list driver's license or ID number:*

Is this a renewal of a previously issued Colorado driver's license or ID?*

Yes

Does your parent/guardian own residential property in Colorado that is your primary residence?*

Yes

Date purchased:*

Address, if different from your permanent address:

Country

Street

City

Region

Postal Code

Does your parent/guardian maintain a home in another state?*

Yes

Has your parent/guardian ever served in the United States military?*

Yes

If so, list dates of service:

From:*

To:*

Dates stationed in Colorado, if any:

From:

To:

Has your parent/guardian paid in-state tuition for you in a state other than Colorado by claiming residence in that state for you during the past two years?*

Yes

If yes, please list institutions:*

Provide any additional information regarding unusual circumstances you would like to have considered.

Disciplinary History

Are you currently under any pending investigations, facing allegations OR been found responsible for a disciplinary violation at any post-secondary institution you have attended for stalking, sexual assault and/or domestic violence?*

Yes

Are you currently under any pending investigations, facing allegations, OR been found responsible for an academic dishonesty violation, such as plagiarism or cheating, at any post-secondary institution you have attended? You only need to report findings of responsibility for academic misconduct if your educational record reflects that you were assigned probation, suspension, removal, dismissal and/or expulsion from the institution. Do not report academic probation and/or suspension due to a low GPA.*

Yes

Have you been found responsible for a disciplinary violation at any post-secondary educational institution you have attended for behavioral misconduct that resulted in a disciplinary action including probation, suspension, removal, dismissal and/or expulsion from the institution?*

Yes

Detailed explanation of incident(s) and outcome (Required)

Please give the approximate date(s) of each incident and your age at the time of the incident, explain the circumstances and reflect on what you learned from the experience. Failure to provide detailed information may delay the processing of your application.

If your school has any documentation concerning your disciplinary incident(s), please upload it here.

Criminal History

You must answer 'yes' to these questions if the conviction was for any type (e.g. simple or aggravated), degree (e.g. first, second, or third), and regardless of whether it was a misdemeanor or felony, enhancement or stand-alone convictions, and where the prosecuting jurisdiction is/was located. You are not required to answer 'yes' to these questions if the criminal adjudication or conviction has been expunged, sealed, annulled, destroyed, erased or otherwise required by law or ordered by a court to be kept confidential. You as the applicant are responsible for providing accurate and thoroughly responsive disclosures to CU Boulder. Failure to do so will jeopardize your admission. Please visit our conduct review page for more information about what crimes should be disclosed, why this information is required, and how it is used in the admission process.

1. Do you have any pending criminal charges?*

Yes

2. Have you been adjudicated guilty or convicted of assault, kidnapping, voluntary manslaughter or murder within five years of submitting your application for admission?*

Yes

3. Have you ever been adjudicated guilty or convicted of stalking, sexual assault and/or domestic violence?*

Yes

4. Are you currently required to register as a sex offender?

Yes

5. Do you have any pending charges OR have you ever been adjudicated guilty or convicted of a misdemeanor or felony?*

If you have been adjudicated guilty or convicted of a DUI, DWAI or other charge related to driving a vehicle under the influence of alcohol or drugs in the past calendar year or have been adjudicated guilty or convicted of more than one DUI, DWAI or other charge related to driving a vehicle under the influence of alcohol or drugs, you must answer "yes" to this question and report these instances.

Note: you are not required to answer "yes" to this question if the criminal adjudication or conviction solely involved the personal use of alcohol or marijuana or has been expunged, sealed, annulled, destroyed, erased or otherwise required by law or ordered by a court to be kept confidential.

Yes

All applicants who answer 'yes' to the criminal history question will go through an additional review once it is determined that the application is academically eligible for admission. This review process may include a background check and some applicants may be asked to provide agency of records which include arrest reports and related court documents. If desired, you may upload these documents below to expedite the review process. More information about the admission procedures for applicants with criminal history can be found on our website.

Arrest reports and court records upload

Aliases. Include all previous names, dates the names were used, reasons (i.e. prior marriage, maiden name, etc.)

Marital status*

Date of marriage*

Date of divorce*

Driver's license number

List all states in which you have lived. If you are not yet in the US, please enter "NA." *

Are you currently on parole or probation?*

Yes

Please provide the name, address, email address, and phone number of your parole or probation officer.

Name*

Agency*

Agency Address*

Country

Street

City

Region

Postal Code

Agency Email Address*

Agency Phone Number*

Please enter the length of your parole or probation.*

Please enter the terms of your parole or probation.*

Are you currently in a community corrections program or a resident of a halfway house?*

Yes

Provide the name, address, and phone number of the facility and your supervisor's name and email address.

Facility name*

Facility phone number*

Facility address*

Country

Street

City

Region

Postal Code

Supervisor name*

Supervisor email address*

Are you currently required to register as a sex offender?*

Yes

List all law enforcement infractions. Detail any additional infractions in the text box provided below.

Incident 1 (All fields required for Incident 1)

Date of incident*

Arresting law enforcement agency (i.e. name of police department or other arresting agency)*

Case Number*

Offense Charged*

Court disposition and sentence (i.e. plea agreement, time in custody, probation terms, etc.)*

Incident 2

Date of incident

Arresting law enforcement agency (i.e. name of police department or other arresting agency)

Case number

Offense Charged

Court disposition and sentence (i.e. plea agreement, time in custody, probation terms, etc.)

Incident 3

Date of incident

Arresting law enforcement agency (i.e. name of police department or other arresting agency)

Case number

Offense Charged

Court disposition and sentence (i.e. plea agreement, time in custody, probation terms, etc.)

Incident 4

Date of incident

Arresting law enforcement agency (i.e. name of police department or other arresting agency)

Case number

Offense Charged

Court disposition and sentence (i.e. plea agreement, time in custody, probation terms, etc.)

Additional incidents if applicable. Be sure to include dates, arresting law enforcement agencies, case numbers, offenses charged, and court dispositions and sentences for each additional incident.

Provide a detailed explanation of the incident(s) and outcome. Include information about what you have done since the incident, treatment you have undergone, lessons learned, etc.*

(Required)

Sign the statement and Authorization for Release of Information below:

By typing my name below, I hereby certify that to the best of my knowledge, the information furnished above is accurate, true and complete. I understand that if it found to be otherwise, it is sufficient cause for refusal, dismissal, or discipline. I authorize representatives of the University of Colorado Boulder to make any and all appropriate inquiries regarding the information listed in this supplement, including conducting a criminal history background check through a third party provider.

I hereby release the university, its officers, employees, and representatives from any liability or damage that may result from furnishing the information requested or conducting the background check.

Applicant signature*

Date*

Terms and Conditions

Please carefully review and consider the agreements and disclaimers presented below. Provide your consent to continue in the application process.

Authorizing the University of Colorado to Process Personal Data

Any personal data that the university collects from you on this site will be for the purposes of planning, organization, enrollment and participation related to the Teacher Leadership program, and performance of academic services in connection therewith, by the University of Colorado and is necessary for those purposes. We are processing your personal information to execute contractual obligations in connection with the previously described purpose such as your enrollment and/or participation in the Teacher Leadership program, including course attendance and other academic requirements, to comply with applicable laws, and in accordance with your consent, when given.

You have the right to withdraw your consent to the collection and processing of sensitive personal data. If you would like to withdraw consent or have any questions about data privacy, please contact privacy@cu.edu.

Having read this notice, by checking the box and continuing the enrollment process I hereby authorize this site and the University of Colorado to process my sensitive personal data and, as needed, transfer my personal data from overseas for the express purposes described above.

I agree to authorize the University of Colorado to process my personal data. *

By submitting your application, you certify that to the best of your knowledge, the information submitted in this application is true and complete. You understand that if found to be otherwise, it is sufficient cause for refusal or dismissal. In addition, you must notify the program if any information provided in this application changes after submission. You also agree to all terms and conditions as discussed in this form.

You also understand that, if admitted to the Master's program, your admission is contingent upon your final credentials reflecting academic achievement similar to the assessment at the time of your admission.

In place of your signature, please type your full legal name and then hit enter:*

Signature = 1