First Name * Last Name * Email Address Cell Phone Number * Home Address * City * State * Zip Code * Active Local Association from which you retired * As an active educator, were you a leader in your district? Please provide: Title of position, Local Association (Active Local or Retired), and dates — as close as you can recall. EXAMPLES: Association Rep, Sumner County EA, 1995 OR Executive Board Member, TRTA, 2010 To help accomplish our goals during the week, you will work both independently and within a team structure thus, providing you opportunities to advance the education profession, assist the local activities, as well as use your vast experience to assist new educators. Due to the nature of the work, we need retirees to drive to site visits at schools (must have a valid driver’s license). Are you comfortable driving a car? * Yes No At a minimum, this is a week-long commitment for each district in which you choose to work. We believe it will be both a thrilling opportunity to help lead this project, and also a demanding regime. Do you have either physical or time limitations that may inhibit your ability to work a full day, full week? * Physical limitations, however, I will help in any way that I am able. Some physical limitations, however, none that will impede driving, walking, chatting with new educators. I have no physical limitations. I will commit the time and be able to accomplish what is needed. Other Please specify your other limitations: * What motivates you to get involved in the "Retired Experience" New Educator Project?