Attachment A

Please complete this online form.  This is the first of two forms (the second being Attachment B to be completed at the end of the school year) that will verify your teaching service for this year, a requirement of the Minority Teacher Education Scholarship. You must complete an Attachment A and B form each school year until you fulfill your obligation to the Florida Fund for Minority Teachers, Inc.

Identification Information
Name *
Name
Home/Cell Phone (Primary) *
Home/Cell Phone (Primary)
Home/Cell Phone (Secondary)
Home/Cell Phone (Secondary)
Address *
Address
Graduation Information
Date of Graduation *
Date of Graduation
If exact day unknown, enter first day of the month.
Date Degree Conferred *
Date Degree Conferred
If exact day unknown, enter first day of the month.
Have you passed all sections of the FTCE? *
Teaching Service Information
School Address *
School Address
School Phone Number *
School Phone Number
Please Note:
3100’s (i.e. 3110, permanent substitute positions, etc.) are now accepted for repayment. If you have any other temporary teaching position (i.e. pool substitute positions, etc.) this does not satisfy the teaching requirement of the Minority Teachers Education Scholarship, and you should contact our office immediately.
If you select other, please provide explanation in comments section below.
Are you teaching in your field of study? *
Please provide pertinent information to your position below.