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Admission & Aid
Cooperative Teacher Application
Early Childhood Educator Certificate program
Thank you for your interest in serving as a Cooperative Teacher in the Early Childhood Educator Certificate program. To qualify, you must be currently employed as a lead teacher in an early childhood setting
and
your employer must agree to your participation in the program.
You will not be able to save your progress, so be ready to complete this application in one session.
Name
Full First Name*
Middle Name
Last Name*
Name (Hidden)
Preferred First Name
Contact Information
Address* (if approved, this is where your paychecks will be mailed)
Address* (if approved, this is where your paychecks will be mailed)
Country
Street
City
Region
Postal Code
Email*
Device Type (Hidden)
Email Address
Evening Phone
Mobile Phone
Primary Phone
Work Phone
Mobile Phone*
Device Type (Hidden)
Email Address
Evening Phone
Mobile Phone
Primary Phone
Work Phone
May we text you at this number?*
May we text you at this number?*
Yes
No
Employment
Current Employer* (If your setting is not listed, then select the option “My center is not listed”)
Center Key
Teaching Position*
What is the highest level of education you have received?* (for reporting purposes only)
High School Diploma or GED
Some College
Associate's degree
Bachelor's degee
Master's degree
Every Cooperative Teacher (CT) is paired with a program candidate to support their professional journey. To serve as a CT, your employer must endorse your application to mentor a program candidate. Approved CTs may work with a
maximum of two candidates
at the same time.
Please list the candidate(s) you wish to mentor.
First Candidate Name
Second Candidate Name (if applicable)
Required Documents
A resume is required as part of the application. You may upload your resume here or email it to eccert@butler.edu after submitting your application.
Program Expectations
Please read each of the following program expectations and acknowledge by checking the box.*
I understand that I must be currently employed in an early childhood classroom in a lead teaching role.
I further understand that the early childhood setting where I am employed must agree to support me in my role as a CT. I understand that my name must either be included on the Program Participation Agreement which is submitted by the program candidate and signed by my early childhood setting leadership, or my name must be submitted by my leadership via email sent to eccert@butler.edu.
I understand that if my application is approved and I am paired with a program candidate that I am required to:
Complete the online, self-paced orientation course provided by Butler (estimated one hour completion time)
Facilitate program-related learning and teaching opportunities in my classroom
Model exemplary teaching practice
Share informal, constructive feedback with candidates
Document formal feedback for Butler faculty
Spend at least one hour weekly with each program candidate debriefing, planning, and sharing insights related to classroom experiences
I understand that if my application is approved and I am matched with a program candidate that I will be compensated by Butler University as follows per candidate that I mentor:
$125 after completing the orientation module and assigned program candidate has completed the first course
$125 after the program candidate has completed 50% of the program
$250 after the program candidate has completed the program and I have submitted all requisite feedback, checklists, and the cooperative teacher survey.
I understand that I am limited to mentoring two program candidates at a time.
I understand that if my application is approved, I will be required to sign a Cooperative Teacher agreement and provide IRS Form W-9. I further understand that I will be acting as an independent contractor (not an employee) and responsible for my own tax reporting.
Signature
I certify that the information contained in this application and all other materials submitted to Butler University are complete and accurate. I understand that any falsification, misrepresentation, or material omission of information may result in the University’s decision that I am not eligible to serve as a cooperative teacher or, if I begin serving, its decision to dismiss me, regardless of the date of discovery, at the sole discretion of Butler University. I understand that after submitting this application and other materials, I must update or supplement my responses if events occur that would change the responses previously provided to the University. I understand that if I fail to do so, the University has the right to take the actions described above in regard to my application or my participation in the program.
I understand that all application materials become the property of Butler University.
If selected as a cooperative teacher, I understand that I am expected to comply with all rules and regulations promulgated by the University. I understand that Butler University may publish my photograph or photographs or videos in which I appear for marketing purposes. Butler University selects cooperative teachers without regard to their race, color, sex, age, national or ethnic origin, religion, sexual orientation, ancestry, military discharge or status, marital status, parental status, or any other protected status. Otherwise qualified persons are not subject to discrimination on the basis of disability.
Signing and submitting your application indicates that you agree to the certification and the other terms and conditions set forth above.
Signature*
Submit
