Fillable I Go to the Head of the Class (Southern Connecticut State University)

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I Go to the Head of the Class (Southern Connecticut State University)

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Minority Teacher Incentive Grant
Connecticut Office of Higher Education,
450 Columbus Boulevard, Suite 510, Hartford, Connecticut 06103-1841
Phone: 860-947-1855 Fax: 860-947-1313 Email: mtip@ctohe.org
I
f you are a college student interested in teaching and a
member of a minority group, the State of Connecticut can
help you with education costs in return for teaching in a
Connecticut public school.
The Minority Teacher Incentive Grant Program provides up to
$5,000 a year for the final two years of full-time study to minority
undergraduates enrolled in a Connecticut teacher preparation
program. The program also provides eligible students with up to
$2,500 in yearly stipends for up to four years of teaching in a
Connecticut public elementary or secondary school.
To qualify, you must:
• be a full-time college junior or senior of African American,
Hispanic/Latino, Asian American or Native American heritage.
2018-2019
PARTICIPATING COLLEGES & UNIVERSITIES
Albertus Magnus College
Joan E. Venditto
Director of Education Programs
jvenditto@albertus.edu
203-773-8087
Central CT State University
Mary Pat Bigley
Interim Associate Dean
School of Education and Professional
Studies
bigleymap@ccsu.edu
860-832-2112
Connecticut College
Dana E. Wright, Chair
Education Department
dana.wright@conncoll.edu
860-439-5115
Eastern CT State University
Elizabeth D. Scott, Interim Dean
School of Education and Professional
Studies/Graduate Division
scotte@easternct.edu
860-465-5293
Fairfield University
Ryan Colwell, Assistant Professor
Educational Studies and
Teacher Preparation
rcolwell@fairfield.edu
203-254-4000 ext. 2586
Quinnipiac University
Beth Larkins-Strathy, Associate Dean
School of Education
beth.larkins-strathy@quinnipiac.edu
203-582-3510
Sacred Heart University
Michael P. Alfano, Dean
Isabelle Farrington College of Education
alfanom3@sacredheart.edu
203-365-4791
Southern CT State University
Deborah Newton, Interim Dean
School of Education
schoolofeducation@southernct.edu
203-392-5900
University of Connecticut
Ann L. Traynor
Director of Advising & Certification
ann.traynor@uconn.edu
860-486-1354
University of Hartford
Lisa Zawilinski, Chair
Department of Education
zawilinsk@hartford.edu
860-768-5718
University of Saint Joseph
Daniel Nussbaum, Interim Chair
School of Education
dnussbaum@usj.edu
860-231-5770
Western CT State University
Maryann Rossi, Associate Dean
School of Professional Studies
rossim@wcsu.edu
203-837-8950
• be nominated by an Education Dean (or appropriate official)
at whichever participating college you attend.
• begin teaching in a Connecticut public school within 16
months of graduation to receive the annual stipend.
To apply, submit a completed nomination form (see reverse
side or download from www.ctohe.org/mtip). For questions,
please contact your Education Dean listed below or Lynne
Goodwin of the Office of Higher Education at 860/947-1855 or
mtip@ctohe.org.
Go to the Head of the Class…
with a Minority Teacher Incentive Grant
2018-2019
Nominees must be full-time juniors or seniors* enrolled in an undergraduate teacher preparation program. Section A is to be completed by the
Nominee. Section B is to be completed by a Dean of Education (or appropriate official) at a participating college or university. Once completed,
submit this form by October 15, 2018 to the Minority Teacher Incentive Grant Program, Office of Higher Education, 450 Columbus Boulevard,
Suite 510, Hartford, CT 06103-1841 • Telephone 860-947-1855 • Fax 860-947-1313 • mtip@ctohe.org
Section A — To be completed by Nominee
Check the appropriate box: Male
■
Female
■
____________________________________________________________________
Name of Nominee (Last, First, MI) Please Type or Print
Telephone (__________)____________________________________ Email___________________________________________________
Permanent Mailing Address __________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
Ethnic Classification: Do you currently have any outstanding educational loans?
■
African American
■
Hispanic/Latino
■
Yes
■
No
■
Asian American
■
Native American
Cumulative Grade Point Average ____________________ Total Credits _____________
Major____________________________________________ College Graduation Date: Mo.______/Yr.______
Minor ___________________________________________ Year in Program in 2018-19:
■
Junior
■
Senior
■
5th Year*
*For Fairfield University, Quinnipiac University, Sacred Heart University and University of Connecticut students only.
High School Name ___________________________________________________ High School Graduation Date: Mo.______/Yr.______
High School Address _______________________________________________________________________________________________________
Have you ever attended a Connecticut community college?
■
Yes
■
No If yes __________________________________________________
Name of College
If awarded a Minority Teacher Incentive Grant, I authorize release of my name for publicity purposes.
■
Yes
■
No
I intend to teach in a Connecticut public school and attest that all information provided above is true and accurate.
_____________________________________________________________________ __________________________________________________
Signature of Nominee Date
Section B — To be completed by Dean of Education (or appropriate college official)
I attest that this student is a full-time, third-year, fourth-year or fifth-year student in our undergraduate teacher preparation
program, and that to the best of my knowledge, the information contained in Section A is correct.
_______________________________________________ _________________________________________ ______________________________
Dean of Education or Designee/Title (Please print) (Signature) (Date)
College Name & Address_____________________________________________________________________________________________________
College Official’s Telephone (__________) ____________________________ College Official’s Fax (________) ___________________________
College Official’s Email_____________________________________________
Go to the Head of the Class…
with a Minority Teacher Incentive Grant
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I Go to the Head of the Class (Southern Connecticut State University)

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Completed 26 August 2020

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