Health Educator Program Application Name(Required) First Last Pronouns (e.g., she/her, they/them)Phone(Required)Personal Email(Required)Please use a “persistent” email address that is unlikely to change over time. Enter Email Confirm Email Work EmailThis is optional. Enter Email Confirm Email Which email address do you prefer for program communication?(Required) Personal Email Work Email Date of Birth(Required)Note: This information is required by the Vermont Agency of Education for licensing programs. Month Day Year Employer(Required)Role(Required)What type of educator license do you currently hold?(Required) Standard Temporary Provisional Emergency None Other If you have a license, what endorsement/s do you hold?What grade level/s do you work with?(Required)What is the highest degree you have earned?(Required)Select the best answer from those below.BachelorsMastersDoctorateOtherFrom which institution did you earn your highest degree?(Required)
