To Use this form, either Print, or "Select All," Copy, and Paste onto a Blank Document. 
Please return along with the completed Health Form by March 1, 2010. Please read the Conditions section carefully before submitting your application. Click here for Student Health Form . Click here for Student Application.

Name: 
            (last)             (first)               (initial)                      Phone(s):                                                      Street Address:

City / State / Zip Code:                                                   E-mail:

To meet the policies of the sponsoring countries, WIESCO programs require that teachers have a college/university degree with some teaching or other relevant experience. WIESCO also accepts university/college students as teachers if they are able to provide acceptable references.
EDUCATION HISTORY:
University/College ( include the schools location and your degree or years completed)
1. 
2. 
EXPERIENCE HISTORY:
1.  Institution (current): 
Department:
Address:                                                                         Phone: 
Name of immediate or past supervisor: 
Address:                                                                         Phone:         
(Please include someone familiar with your work as one of your references)
2. Other teaching experiences:

3. Have you any ESL teaching experience? Explain:

4. Have you had any previous experience teaching English outside the United States?
If "yes" where and when? With what organization?

STATEMENT OF INTEREST: PLEASE RESPOND TO THE FOLLOWING:
1. Why are you interested in teaching outside the U.S.?

2. What experiences have you had that you can share with international students?

REFERENCES:
Please provide letters recommendation from two persons who are not related to you.
1.

2.
PLEASE RANK YOUR PREFERENCE OF PLACES TO TEACH:
_____ Poland
_____ Latvia

_____Macedonia
ADD ANY FURTHER INFORMATION WHICH YOU THINK MAY BE OF IMPORTANCE FOR THE APPLICATION:

AUTHORIZATION:
I certify that the facts in this application are true. I authorize investigation of all statements contained herein concerning my performance as a teacher.

Signature:                                                                    Date: 
Please include with the application:
     1. A check for $300 ($200 for students) registration fee.
     2. A RECENT PICTURE of yourself

Due on March 1, 2010
Mail to: WIESCO, INC.
15065 Shoreline Drive
Merrill, WI 54452