The Urban Learning Teachers Association



 Application for Membership

Urban Learning Teachers Association






Mailing Address                                                                                                             


City                                                          State              Zip Code                                      


Home phone #   (            )                                        Cell # (           )                                 

Good times to call:                                          Good times to call:                                 


E-mail Address                                                                      


Cohort # and year: (if applicable)                            Year of expected graduation:                             


Are you an instructional assistant?  _________  

            If so, for what school district?________________________


Are you teaching with an emergency credential?  _________          

            If so, for what school district? _________________________


Areas of interest

Would you be interested in or like to participate in any of the following committees or capacities?



Community Service              


Social Activities                

Guest Speakers                   

Technology/Web Design              

            Other Ideas:                                                                                     


I would be interested in holding an office and/or committee position. 

                                        Yes _____  No _____

I am interested in:





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Last updated: 04/16/03.