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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