Name *

First Name

Last Name

Phone *

(###)

###

####

Which best describes you? *

(check all that apply)

Future teacher

Current teacher

School or district staff

College student

Partner institution staff

I'm not sure yet

What are you hoping to do next? *

(check all that apply)

Finish my degree

Earn a teaching certification

Add an endorsement

Support others in my district

I'm exploring options and want to talk to someone

Current Level of Education *

Select the highest level you’ve completed:

High School or GED

Some college, no degree

Associate degree

Bachelor’s degree (non-teaching)

Bachelor’s degree (teaching certification)

Master’s degree or higher

Other / Not listed

Current role *

Aspiring teacher / Future educator

Current teacher (certified)

Substitute teacher

Paraprofessional / Classroom support staff

School or district administrator

College student (teacher prep or education-related)

Faculty or staff at a teacher preparation institution

Other / Not listed

What is your connection to a rural district? *

I currently work in a rural school district

I live in a rural community

I grew up in a rural community

I want to work in a rural school district

I support rural schools through my organization or institution

Not sure / Need help determining this

Are you interested in earning a specific certification or endorsement? *

Birth–Kindergarten (B-K) teaching certification

PreK–3 teaching certification

Grades 3–6 teaching certification

Grades 5–9 teaching certification

Grades 7–12 teaching certification

Special education certification

Administration certification

Adding an endorsement to my current certification

Not sure—need help deciding