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IMPORTANT: Information gathered below is necessary for management of the ReadOregon program. One-time completion of this form is required. You must also be formally admitted to your home institution in order to earn your 24-credit reading endorsement.
If important personal information changes, e.g., new address or phone number, different school, updated license status, changing home institution, please submit a second application.
Decline to answer
Highest degree earned
(Please fill in ethnic group or tribal affiliation in space provided)
Black or African American, Non-Hispanic
Hispanic or Latino
Native Hawaiian or Pacific Islander
American Indian or Alaskan Native
Decline to respond
Teaching license status
Oregon Basic or Standard license (prior to 1999)
Oregon Transitional license
Oregon Initial license
Oregon Continuing license
License authorization levels
Endorsement area (if applicable)
Full-time teacher working in Oregon
Substitute teacher working in Oregon
Part-time teacher working in Oregon
Instructional Assistant working in Oregon
Administrator working in Oregon
Have teaching license, but not teaching
Name of your school
City/town of your school
Years of teaching in early childhood or K-12 classrooms
Are you currently enrolled in a master's or teacher prep program? If yes, please list the name of institution and program.
Read Oregon program in which you are interested
12-credit literacy certificate
Courses for professional development
University you want as your "home institution"
(You may choose any of the following two universities as your "home" regardless of where you live. If you are enrolled in a master's program, choose that university as your home institution. )
Portland State University
Southern Oregon University
How did you hear about Read Oregon
At school or from principal
Read Oregon flyer
Does your district provide funds for professional development?
Why are you interested in the Read Oregon programs?
Other questions or comments
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