ECE Teacher Training Incentive Program
$1,000 Grant Application
 

     Last Name  E-mail Address

    First Name    Middle Name (Required)  Title

    Maiden Name   Male Female    Birthdate (m/d/y)

  Address CityStateZip(Required)

   Home phone#:

    If you are currently serving in a congregation, complete the following:

    Congregation      City/State  

Are you member of a WELS congregation?YesNo

    If YES, what is the name of the congregation?

What is your present occupation?

Are you a college graduate? Yes  No
    If yes, what is the name of the institution?
    Month/Year of graduation:

Do you have a valid state teaching license?

School/Center at which you teach:

Address of School/Center:

School Center City, State, Zip:

I realize that by applying for this grant, I must complete the three specified ECE courses before I am eligible for the $1,000 grant.  Grant monies will be available on a pro-rated basis for those who have already taken one or two of the courses.

I agree to the above condition Yes  No
   

  If you do not see a receipt for this application within a minute, please report the problem to : balgejl@mlc-wels.edu

                    Last updated 06-30-2006