Student Teacher Enrollment Form – United Educators Association of Texas

School District

Please type in the name of the district where you are doing your student teaching.

Full Name *

First

Last

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Best Contact Phone Number *

Best Email Address *

District Email Address

Current Position *

Campus / Department Assignment

Student Teacher Membership Agreement

By signing below, I hereby agree to become a member of the United Educators Association as a Student Teacher. I understand my dues will be free for the current School Year. When you obtain your first position, this membership will not automatically carry over. You will need to complete a new enrollment form as a New UEA Member.

Signature *

Please use your mouse to sign here.