Roster Form for Segue EmailThis field is for validation purposes and should be left unchanged.Please select your role:Educator / AdministratorCommunity PartnerStudent Name(Required) First Last Email(Required) OrganizationThis field is hidden when viewing the formOrganizationHow many years have you worked in education (in any capacity)?(Required)0-3 Years4-7 Years8-9 Years10-15 Years16-20 years21-24 Years25+ YearsN/AHow many years have you worked in your current job role and district?(Required)0-3 Years4-7 Years8-9 Years10-15 Years16-20 years21-24 Years25+ YearsN/AWhat is (are) your current job role(s)? (Select all that apply)(Required) Teacher Special Ed. Teacher Teaching Assistant Paraprofessional Instructional Coach Instructional Specialist Counseling Staff Health Staff Athletics Coach Administrative Support Staff School/Building Administrator District Administrator Community Member/Partner Community Educator Pod Leader Parent Student Other Which grade level(s) do you currently teach? (Select all that apply)(Required) Administrator Pre-Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Other grade(s) Which subject(s) do you currently teach? (Select all that apply)(Required) All Elementary Subjects English Language Arts Reading/Literacy Math Science Computer Science/Technology Social Studies/History World Language Special Education Speech and Language Multilingual Learners Business Culinary Arts Driving Fine Arts GED/Adult Education Health Library Music Physical Education Religion Social Skills (wellness, identity, intersectionality) Theater Other subject(s) N/A - Administration N/A - Support Staff Which gender identity(ies) do you most identify with? (Select all that apply)(Required) Boy/Man Girl/Woman Cisgender Genderfluid Genderqueer Intersex Nonbinary Questioning Transgender A gender identity not listed here Prefer not to share my gender identity(ies) Which sexual orientation do you most identify with? (Select all that apply)(Required) Asexual Bisexual Gay Straight (heterosexual) Lesbian Pansexual Queer Questioning or unsure Same-gender loving An identity not listed here Prefer not to share my sexual orientation Which racial or ethnic identity(ies) do you most identify with? (Select all that apply)(Required) Asian Pacific Islander or Native Hawaiian Black or African American Hispanic or Latino/Latinx/Latina/Latine Middle Eastern or North African Native American or Alaskan Native White or Caucasian Multiracial or Biracial A race/ethnicity not listed here Prefer not to share my racial or ethic identity(ies) Receive updates in your inbox (optional) Yes! Please sign me up for the Throughline Learning e-newsletter. This field is hidden when viewing the formSession IDThis field is hidden when viewing the formOrganization IDThis field is hidden when viewing the formEngagement IDThis field is hidden when viewing the formSession Domains
