Future Educators Club of Potomac Falls



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Educators Rising Club of Potomac Falls

Application for Membership

Name ____________________________ Age ________ Grade ________

Address _____________________________________________________________

Parent Name(s)________________________________________________

Your Phone # _____________________ Cell

Phone #__________________________Home

E Mail address__________________________________________________

Do you drive to school? Yes No

Would you be able to provide transportation for other ER members, assigned to the same school if they do not have transportation? Yes No

Have you been a member of Educators Rising before this year? Yes No

If yes, how many years? _____________

Is it your desire to someday pursue a career in education? Yes No

If so, what level? Elementary Middle High

Briefly explain why you want to be a member of Educators Rising and what you hope to experience?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Educators Rising Dues - $20.00 Please make checks payable to Potomac Falls High School

Class schedule:

Class Teacher Room#

1) _____________________________________________________________

2) _____________________________________________________________

3) _____________________________________________________________

4) _____________________________________________________________

5) _____________________________________________________________

6) _____________________________________________________________

7)

_____________________________________________________________

Return completed applications with your dues to Mrs. Anfindsen room 112 ASAP – if you have a teacher, school or grade preference for Tuesday morning tutoring please indicate this on the line below.

Please understand that you may not get your request if the teacher does not want to participate in Educators Rising this year or if I have too many requests for one school – we need to have tutors at all four elementary schools.

_____________________________________________________________

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