Serving Native Schools Project

Associate of Arts Degree Program

Application

Full Name_______________________________________________________________

Permanent Mailing Address_________________________________________________

City _________________________SD_______________Zip______________________

Birthdate_______________________Social Security Number______________________

Home Phone Number ______________________________________________________

Email address____________________________________________________________

Currently working as a paraprofessional: Yes No Part-time

School__________________________________________________________________

School Address___________________________________________________________

School Phone Number___________________School Fax Number___________________

Supervisor_______________________________________________________________

How far do you live and/or work from a college or college center?___________________

Indicate your comfort level using a computer?

What is your educational background (HS diploma, GED, college courses)?

How many credits toward an AA degree do you already have?_________________

What goals have you set for yourself in regards to your education?

Send to: Susan Conrad, PO Box 490, Kyle, SD 57752 Ph. 455-6094 Fax 455-2603.

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Serving Native Schools Project

Associate of Arts Degree Program

School Commitment Form

As a partner in the Serving Native Schools Project we agree to:

• Provide 3 hours release time per week for _________________________________to participate in courses.

• To be responsible for securing and maintaining connectivity for video conferencing courses and training during the academic year.

__________________________________________ Date____________________

Signature of Authorized School District

Representative

__________________________________________

Position

Serving Native Schools Project

Associate of Arts Degree Program

Applicant Agreement Form

Applicant will:

· Complete and submit all appropriate application forms.

· Complete and submit all required information and reports as necessary for program evaluation.

· Notify OLC about any change of employment as soon as possible after such change has occurred.

· Notify OLC about any and all changes in contact information (address, phone number, etc.).

__________________________________________ Date____________________

Signature of Authorized School District

Representative

__________________________________________

Position

__________________________________________

Signature of Applicant