Associate Teacher Program Application Applicant Information Name Address Telephone Email Disclosure of gender and/or racial identity information is voluntary and will be used for demographic reporting Belmont Day School welcomes people of all races, religions, family configurations, gender identities, sexual orientations, economic backgrounds, and cultural identities We work together to nurture a community where listening, open dialogue, humor, and respect thrive Gender Identity Racial Identity o American Indian/Alaska Native o Asian o Latino/a o Biracial/Multiracial o Black/African American o Middle Eastern o Pacific Islander o White/Caucasian How did you find out about Belmont Day School’s Associate Teacher Program? Acquaintance: _ Website: _ Recruiting Event: _ Advertisement: Social Media: Other: Program Information Select the program for which you wish to apply o Early Childhood (Pre School - Grade 2) o Elementary Education (Grades - 6) Have you applied to the Graduate School of Education at Lesley University? Are you currently enrolled in the Graduate School of Education at Lesley? o o yes yes o o no no Academic and Professional Information and Transcripts Please list all relevant post-secondary studies and work experiences If additional space is needed, continue on another page Official sealed transcripts are required from each college or university attended If you are accepted to the Belmont Day School Associate Teacher Program, the transcripts will be forwarded to Lesley’s admissions office Name of Institution or Employer Years of Attendance or Employment Degree earned or responsibilities 55 Day School Lane Belmont, MA 02478 617 484 3078 www.belmontday.org References Please include letters of recommendation from two individuals who have supervised you in an academic or professional setting Reference letters should provide details of your studies or work, and an assessment of your ability to engage in graduate studies while taking on the responsibilities of an associate teacher Name of Individual Institution or Affiliation Contact Information Please note that in addition to the reference letters written for your application to the Belmont Day School Associate Teacher Program, you will need to submit Lesley University’s official recommendation forms with your application to Lesley We suggest that you ask each of your references to complete the Lesley recommendation form (available from the admissions office or on the web at www.lesley.edu) at the same time that they write your letters for the Associate Teacher Program All of the recommendation materials may be submitted to Belmont Day School; they will be returned to you, or, if you are accepted to the Associate Teacher Program, they will be forwarded to the admissions office at Lesley Personal Statement One of the hallmarks of the Belmont Day School/Lesley Collaborative program is the connection between educational theory and classroom practice Students in the Belmont Day School program are expected to demonstrate intellectual curiosity, an interest in children’s development, and a desire to learn in an apprenticeship role Please describe a question, observation, or educational interest that has led you to apply to the Associate Teacher Program In addition, please explain how this program will help you gain further insight into the question or interest you have identified Attach your personal statement to the application 55 Day School Lane Belmont, MA 02478 617 484 3078 www.belmontday.org