E-Teacher Program Application
Please send the completed application to
RELOMexico@state.gov
by Monday, July 2, 2018
The Fall term will run from September 25 to November 20, 2018
Participants will also have to complete a mandatory orientation module prior to the start of the course.
 Instructions:
• You will need to have Microsoft Office for the form to have full functionality. If you use Open Office
or Google Docs, the form will not work correctly.
• Download the application form to your computer. Save it to your hard disk with your last names
before the current file name. Example: Perez Martinez 2018 AE E-Teacher Application Fall.doc
• Read the format carefully before filling it out. Make sure to include all of the information required.
• To start filling out the format, use the TAB key. You will only be able to type in the shaded areas.
• To move from one box to the next, use the TAB key or the → ↑ arrow keys. To move back, press
SHIFT (mayúsculas) and TAB at the same time or use the ← ↓ arrow keys.
• To check a box, click on it or type X. To uncheck it, click on it again or type X again.
• Should you have any questions or need help to fill out this form, please contact José Manuel
Villafuerte – 01-55-5080-2000, ext. 5269.
General information
Full name as you wish it to appear on your certificate:      
Country of residence:      
State of residence:       City of residence:      
Are you a Mexican citizen? Yes No
Will you be living in Mexico during the AE E-Teacher course? Yes No
E-mail address:      
Cell phone number: 044      
School/Institution you work at:      
Questions? Contact us: RELOMexico@state.gov
01 (55) 5080-2000 ext. 5269
E-Teacher Program Application
What do you do? (Check all the boxes that apply.)
Soy formador de profesores en un programa de licenciatura en una escuela Normal o
Universidad
Doy capacitación a profesores de inglés (enlace/asesor técnico-pedagógico o similar)
Superviso a profesores (coordinador, director, jefe de departmento, etc.)
Soy profesor/instructor de inglés
Otro (especifique)      
I am interested in taking the following course:
Content-Based Instruction
Statement of Purpose: Please explain in English why you want to participate in the course
you selected. What impact will your participation in this program have on your institution, or
region, and how do you expect to use the knowledge acquired in this course?
MAXIMUM LENGTH: ABOUT HALF A PAGE. ADDITIONAL PAGES WILL NOT BE ACCEPTED.
     
Impact: How will you share the information you will learn with your colleagues after the
completion of the course? (Check all the boxes that apply.)
Presentations Conventions
Workshops Distributing Material
Other (specify)      
Language Proficiency: How good is your English? (Select the best option.)
Reading comprehension Excellent Good Fair
Questions? Contact us: RELOMexico@state.gov
01 (55) 5080-2000 ext. 5269
E-Teacher Program Application
Expressing yourself in written English Excellent Good Fair
Computer Skills: Please evaluate your computer skills. (Select the best option.)
Excellent Good Fair None
Internet Access and Time Commitment: Please respond to the following questions.
I have regular and reliable access to high-speed internet connection. Yes No
I can commit to spending about 2 hours every day for the
duration of the 8-week course to complete it successfully. Yes No
I have taken an online course before. Yes No
Questions? Contact us: RELOMexico@state.gov
01 (55) 5080-2000 ext. 5269

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2018 ae e teacher application fall

  • 1. E-Teacher Program Application Please send the completed application to RELOMexico@state.gov by Monday, July 2, 2018 The Fall term will run from September 25 to November 20, 2018 Participants will also have to complete a mandatory orientation module prior to the start of the course.  Instructions: • You will need to have Microsoft Office for the form to have full functionality. If you use Open Office or Google Docs, the form will not work correctly. • Download the application form to your computer. Save it to your hard disk with your last names before the current file name. Example: Perez Martinez 2018 AE E-Teacher Application Fall.doc • Read the format carefully before filling it out. Make sure to include all of the information required. • To start filling out the format, use the TAB key. You will only be able to type in the shaded areas. • To move from one box to the next, use the TAB key or the → ↑ arrow keys. To move back, press SHIFT (mayúsculas) and TAB at the same time or use the ← ↓ arrow keys. • To check a box, click on it or type X. To uncheck it, click on it again or type X again. • Should you have any questions or need help to fill out this form, please contact José Manuel Villafuerte – 01-55-5080-2000, ext. 5269. General information Full name as you wish it to appear on your certificate:       Country of residence:       State of residence:       City of residence:       Are you a Mexican citizen? Yes No Will you be living in Mexico during the AE E-Teacher course? Yes No E-mail address:       Cell phone number: 044       School/Institution you work at:       Questions? Contact us: RELOMexico@state.gov 01 (55) 5080-2000 ext. 5269
  • 2. E-Teacher Program Application What do you do? (Check all the boxes that apply.) Soy formador de profesores en un programa de licenciatura en una escuela Normal o Universidad Doy capacitación a profesores de inglés (enlace/asesor técnico-pedagógico o similar) Superviso a profesores (coordinador, director, jefe de departmento, etc.) Soy profesor/instructor de inglés Otro (especifique)       I am interested in taking the following course: Content-Based Instruction Statement of Purpose: Please explain in English why you want to participate in the course you selected. What impact will your participation in this program have on your institution, or region, and how do you expect to use the knowledge acquired in this course? MAXIMUM LENGTH: ABOUT HALF A PAGE. ADDITIONAL PAGES WILL NOT BE ACCEPTED.       Impact: How will you share the information you will learn with your colleagues after the completion of the course? (Check all the boxes that apply.) Presentations Conventions Workshops Distributing Material Other (specify)       Language Proficiency: How good is your English? (Select the best option.) Reading comprehension Excellent Good Fair Questions? Contact us: RELOMexico@state.gov 01 (55) 5080-2000 ext. 5269
  • 3. E-Teacher Program Application Expressing yourself in written English Excellent Good Fair Computer Skills: Please evaluate your computer skills. (Select the best option.) Excellent Good Fair None Internet Access and Time Commitment: Please respond to the following questions. I have regular and reliable access to high-speed internet connection. Yes No I can commit to spending about 2 hours every day for the duration of the 8-week course to complete it successfully. Yes No I have taken an online course before. Yes No Questions? Contact us: RELOMexico@state.gov 01 (55) 5080-2000 ext. 5269