RETURN 5 STAPLED COPIES OF THIS BIOGRAPHICAL DATA SHEET WITH YOUR PERSONAL ESSAY AND INTERNSHIP APPLICATION TO RENE LOY IN EDC 247 Q1 DATE Q2 MAJOR
Q3 GRADE LEVEL   --Click Here--P-44-87-12P-8, 7-12
Q4 SELECT ONE   --Click Here--Early Childhood P-4 Middle School 4-8 LA/SSMiddle School 4-8 Math/Science Q5 SECONDARY   --Click Here--ArtBusinessEnglishFamily & Consumer ScienceForeign LanguageMathMusc (Instrumental)Music (Vocal)Physical Education & HealthSocial Science

Q6 Name (Last Name, First Name) Q7 AGE Q8 GENDER   Male Female Q9 CAMPUS ADDRESS Q10 CAMPUS PHONE (ex. 501-111-1111) Q11 HOME ADDRESS Q12 DAYTIME NUMBER (ex. 501-111-1111) Q13 HOME NUMBER  (ex. 501-111-1111) Q14 ALTERNATE EMAIL ADDRESS Q15 CAMPUS EMAIL ADDRESS Q16 STATUS (check all that apply)   Single Married Head of Household   Q17 CHILDREN   --Click Here--YesNo Q18 If yes, how many children?

Q19 CAR AVAILABLE FOR TEACHER INTERNSHIP     --Click Here--YesNo Q20 HIGH SCHOOL ATTENDED Q21 HIGH SCHOOL GRADUATION YEAR Q22 COLLEGES ATTENDED (PLEASE LIST ALL ATTENDED)

Q23 OFFICES HELD AND AWARDS RECEIVED IN COLLEGE Q24 EXPERIENCES WORKING WITH CHILDREN

Q25 EDUCATIONAL WORK EXPERIENCES Q26 SPECIAL ABILITIES, HOBBIES, RECREATIONAL AND READING INTERESTS