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Culture Keeper Application - IDENTITY JOURNEY TM
Complete this application so we can get to know you.  Takes 10 minutes.  


Section 1: Basic information

Section 2: Teaching Background

Are you a retired educator?
What grade level (s) did you primarily teach?
Do you hold a current or lapsed teaching certification/license?
Have you worked with Black children specifically in an educational, mentorship or community setting?

Section 3: Program Fit

Section 4: Availability and commitment

Can you commit to the same weekly time slot for a full 8-week cohort; with one live 45-minute session per week?
Preferred days of the week for the live session
Preferred time of day for the live session
Are you comforable with about 15 minutes of weekly administrative tasks, including Educator Portal updates and follow-up emails?
Are you available for certification training prior to starting Cohort 1?
Would you be interested in leading more than one cohort if the pilot goes well?

Section 5: Technology Readiness

Do you have a quiet, private and professional space in your home where you can deliver live online sessions without background noise, interruprions or distractions?
Yes
No
Do you have reliable high-speed internet access?
Do you have access to a computer or tablet with a working camera and microphone?
How comfortable are you using video conferencing tools such as Zoom? Multi choice

Section 6: Independent Contractor Acknowledgement

This is an independent contractor role, not an employee position. Culture Keepers deliver Identity Journey tm under contract, set their own schedule within the cohort structure, and are responsible for their own taxes (1099).

I consent to a background check if selected to move forward

Section 7: References

Referral Source

Section 8: Final details

Date
Month
Day
Year
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