APPOINTMENT DETAILSInterviewer Name(Required)Interviewer's Personal Email(Required) Date(Required) MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Location NameLocation Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe 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conversation scheduled date MM slash DD slash YYYY Follow-up conversation scheduled time Hours : Minutes AM PM AM/PM MEMBER INFORMATIONMember Name(Required) First Last Member's Personal Email(Required) Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell PhoneGenderMaleFemaleTransgenderGender NeutralNon-BinaryMEMBERSHIP INFORMATIONCurrent Employer(Required)ASPIRING EDUCATORADA EX VILL SDADENA LOCAL SDAKRON CITY SDALEXANDER LOCAL SDALLEN COUNTY BD OF MRALLEN EAST LOCAL SDALLIANCE CITY SDAMANDA-CLEARCREEK LOCAL SDAMHERST EX VILL SDANNA LOCAL SDANSONIA LOCAL SDANTHONY WAYNE LOCAL SDANTWERP LOCAL SDAPOLLO JVSDARAMARK EDUCATIONAL SERVICESARCANUM BUTLER LOCAL SDARCHBOLD-AREA LOCAL SDASHLAND CITY SDASHLAND COUNTY BD OF MRASHLAND COUNTY-WEST HOLMES JVASHTABULA AREA CITY SDASHTABULA COUNTY BD OF MRASHTABULA CTY TECHNICAL AND CAREER CENTERATHENS CITY SDATHENS COUNTY BOARDAUBURN JVSDAURORA CITY SDAUSTINTOWN LOCAL SDAVON LAKE CITY SDAVON LOCAL SDAYERSVILLE LOCAL SDBARBERTON CITY SDBARNESVILLE EX VILL SDBATAVIA LOCAL SDBATH LOCAL SDBAY VILLAGE CITY SDBEAVER LOCAL SDBEAVERCREEK LOCAL SDBEDFORD CITY SDBELLAIRE CITY SDBELLEFONTAINE CITY SDBELLEVUE CITY SDBELMONT-HARRISON JVSDBELPRE CITY SDBENJAMIN LOGAN LOCAL SDBENTON CARROLL SALEM LOCAL SDBERKSHIRE 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LOCAL SDWAYNE TRACE LOCAL SDWAYNESFIELD-GOSHEN LOCAL SDWELLINGTON EX VILL SDWELLSTON CITY SDWELLSVILLE LOCAL SDWEST BRANCH LOCAL SDWEST CARROLLTON CITY SDWEST CLERMONT LOCAL SDWEST GEAUGA LOCAL SDWEST LIBERTY-SALEM LOCAL SDWEST MUSKINGUM LOCAL SDWESTERN BROWN LOCAL SDWESTERN LOCAL SDWESTERN RESERVE LOCAL SD - (MAHONING)WESTERN RESERVE LOCAL SD (HURON)WESTERVILLE CITY SDWESTFALL LOCAL SDWESTLAKE CITY SDWHEELERSBURG LOCAL SDWHITEHALL CITY SDWICKLIFFE CITY SDWILLARD CITY SDWILLIAMSBURG LOCAL SDWILLOUGHBY-EASTLAKE CITY SDWILMINGTON CITY SDWINDHAM EX VILL SDWINTON WOODS CITY SDWOLF CREEK LOCAL SDWOOD COUNTY BD OF MRWOODMORE LOCAL SDWOODRIDGE LOCAL SDWOOSTER CITY SDWORTHINGTON CITY SDWYNFORD LOCAL SDWYOMING CITY SDXENIA CITY SDYELLOW SPRINGS EX VILL SDYOUNGSTOWN CITY SDYOUNGSTOWN STATE UNIVERSITYZANE TRACE LOCAL SDZANESVILLE CITY SDLocal Name(Required)ASPIRING EDUCATORACCESSADA CLASSIFIED ASSOCIATIONADA E. A.ADENA E. A.AKRON CLASSIFIEDALEXANDER LOCAL E.A.ALLEN EAST E. A.ALLIANCE E. A.AMANDA-CLEARCREEK E.A.AMANDA-CLEARCREEK S.S.A.AMHERST T.A.ANNA LOCAL T.A.ANSONIA E.A.ANSONIA LOCAL SUP PERSANTHONY WAYNE E. A.ANTWERP E. A.APOLLO E.A.ARCANUM BUTLER C.T.A.ARCHBOLD E. A.ASHCO D.D. E.A.ASHLAND CITY T. A.ASHLAND VOCATIONAL T.A.ASHTABULA A.C.S.E.ASHTABULA AREA T.A.ASHTABULA CO. EMP. ASSN.ASHTABULA JVSD T AATCO - BEACON E. A.ATHENS E. A.AURORA E. A.AUSTINTOWN E. A.AVON LAKE E. A.AVON T. A.AYERSVILLE E.A.BADGER E. A.BARBERTON E. A.BARNESVILLE A CLASS EMPBARNESVILLE E.A.BATAVIA PROF. E.A.BATH E. A.BAY INDIV-SM GROUP INST TABAY T.A.BEAVERCREEK CLASSIFIED EMPBEAVERCREEK E.A.BEAVER LOC. E.A.BEDFORD E.A.BELLAIRE E.A.BELLEFONTAINE E. A.BELLEVUE E. A.BELMONT-HARRISON VOC. E.A.BELPRE E.A.BENJAMIN LOGAN E. ABERKSHIRE E. A.BERNE UNION E.A.BETHEL E.A.BETHEL-TATE T.A.BEXLEY E.A.BIG WALNUT E. A.BIG WALNUT PROF S.S.BLACK RIVER S.S.P.BLACK RIVER T. A.BLANCHESTER E ABLOOM CARROLL E.A.BLOOMFIELD-MESPO E. A.BLUFFTON E. A.BOARDMAN E. A.BOWLING GREEN E. A.BRADFORD T. A.BRECKSVILLE BRDVIEW HTS E ABRECKSVILLE BRDVIEW HTS S SBRIDGEPORT A. OF CLSS.BRIDGEPORT E. A.BRIGHT T.E.A.BRISTOL A. OF SCHL EMP.BROOKFIELD ASSN OF SCHL EMPBROOKLYN E. A.BROOKVILLE T. A.BRUNSWICK E. A.BRUNSWICK E.S.P.BRYAN E. A.BUCKEYE CENTRAL E. A.BUCKEYE E. A. ASHTABULABUCKEYE E.A. J.V.S.BUCKEYE HILLS S.S.BUCKEYE HILLS T.A.BUCKEYE LOC C.T.A.BUCKEYE VALLEY T. A.BUCYRUS E. A.BUCYRUS ORG OF S.S.BUTLER EDUCATION ASSNCALDWELL T. A.CAMBRIDGE T.A.CAMPBELL E. A.CANAL WINCHESTER E. A.CANFIELD BUS DRIVERS ASSNCANFIELD E. A.CANTON LOCAL CLSFD ASSNCANTON LOCAL E. A.CANTON PROF E. A.CARDINAL E. A.CARDINGTON-LINCOLN FAC.CAREER AND TECHNICAL ASSNCAREY E. A.CARLETON SHL MEIGS INDCARLISLE T. A.CARROLLTON E. A.CEDAR CLIFF E. A.CELINA E. A.CENTERBURG T.A.CENTERVILLE C.T.A.CHAGRIN FALLS E.A.CHAMPION E.A.CHAMPION LOCAL S.S.P.CHARDON ACECHARDON E. A.C H A S ECHESAPEAKE LOCAL T.A.CHILLICOTHE E. A.CHIPPEWA E.A.CIRCLEVILLE E. A.CLARK CO VOC ASSN OF SECLARK CO VOCATIONAL E.A.CLARK-SHAWNEE LOCAL E.A.CLAY E.A.CLAYMONT E.A.CLEARVIEW E. A.CLERMONT COUNTY SPECIAL E ACLERMONT NE E. A.CLINTON MASSIE E.ACLOVERLEAF E. A.CLYDE GREEN SPRINGS E.A.COL CRAWFORD E. A.COLDWATER T.O.COLUMBIA LOC E. A.COLUMBIANA ASSOCIATED EMPLCOLUMBIANA E.A.COLUMBIANA LOCAL ASSN OF SSCOLUMBUS E. A.COLUMBUS GROVE E. A.COLUMBUS STATE E. A.CONNEAUT CLASS EMPL.CONNEAUT E. A.CONOTTON VALLEY T.A.CONTINENTAL E. A.COPLEY T.A.COSHOCTON CITY E. A.COSHOCTON COUNTY C.C. E.A.COVENTRY E ACOVINGTON E.A.CRESTLINE E.A.CRESTVIEW E.A.- COLUMBIANACRESTVIEW T. A.- RICHLANDCRESTWOOD E.A.C-T E C T.E.A.CUYAHOGA FALLS E. A.CUYAHOGA HTS A OF TDALTON LOCAL E. A.DANBURY ASSN NON-TEACHINGDANBURY E.A.DAWSON BRYANT E. A.DAYTON E ADEER PARK E. A.DEFIANCE CITY E. A.DELAWARE AREA CAREER CTR E.A.DELAWARE CITY T. A.DELPHOS E. A.DOVER E.A.DUBLIN E.A.DUBLIN SUPPORT ASSOCIATIONEAST CANTON E.A.EAST CLEVELAND E. A.EAST CLINTON E. A.EASTERN GATEWAY COM COL E AEASTERN LOCAL C.T.A.- PIKEEASTERN LOCAL E.A.- BROWNEASTERN LOCAL E.A.- MEIGSEASTERN LOCAL S.S.P. ASSNEAST GUERNSEY LOCAL S.A.EAST GUERNSEY LOCAL T.A.EAST HOLMES T. A.EAST KNOX E. A.EASTLAND E. A.EAST LIVERPOOL E.A.EAST PALESTINE E. A.EASTWOOD E. A.EATON C.T.A.EATON S.S.P.ED. ASSN OF ORRVILLEED. ASSN OF PIONEERED. OF MONTGOMERY COUNTYEDGERTON E. A.EDGEWOOD T.A.EDISON LOC E. A.EDISON STATE E.A.EDISON T. A.EDON NORTHWEST T.A.EHOVE T. A.ELGIN E.A.ELIDA E.A.ELMWOOD E. A.ELYRIA E. A.EUCLID CLASSIFIED ASSNEUCLID CLSFD - TRANSPORTATIONEUCLID T. A.EVERGREEN E. A.FAIRBANKS E. A.FAIRBORN E. A.FAIRFIELD C.T.A. BUTLERFAIRFIELD E.A. HIGHLANDFAIRFIELD UNION E.A.FAIRLAND A.C.T.FAIRLESS E. A.FAIRPORT HARBOR T.A.FAIRVIEW PARK E.A.FAYETTEVILLE-PERRY CLSFD EAFAYETTEVILLE-PERRY E.A.FEDERAL HOCKING T.A.FELICITY E.A.FIELD LOCAL T.A.FINDLAY E. A.FINNEYTOWN A.S.P.FINNEYTOWN E.A.FIRELANDS E.A.FOREST HILLS T.A.FOREST ROSE E.A.FORT FRYE T. A.FORT JENNINGS E. A.FORT LORAMIE E.A.FORT RECOVERY E. A.FOSTORIA E. A.FOUR COUNTY J.V. E.A.FRANKLIN COUNTY BD OF DD EAFRANKLIN E. A.- WARRENFRANKLIN LOCAL T.A.FRANKLIN MONROE E. A.FREDERICKTOWN E. A.FREMONT E. A.FRONTIER LOC. E.AGAHANNA-JEFFERSON E. A.GALION E.A.GALLIA CO. LOCAL E.A.GALLIA CO. LOCAL S.S.GALLIPOLIS E. A.GARAWAY T.A.GARFIELD E. A.GARFIELD HTS T. A.GEAUGA SCHOOL EMPL ASSNGENEVA AREA T AGIBSONBURG T. A.GIRARD E. A.GOOD SAMARITAN E.A.GORHAM FAYETTE T.A.GOSHEN E.A.GOSHEN E.A.- S.S.A.GRAHAM E. A.GRAND VALLEY S.S.P.GRANDVIEW HTS E.A.GRANDVIEW HTS EDUC. S.S.A.GRANVILLE E. A.GREEN E. A.- SUMMITGREENE COUNTY C.C. E AGREENE COUNTY C C CLSFD E AGREENEVIEW CLASSIFIED E.A.GREENEVIEW E. A.GREENFIELD EX VLG E.A.GREEN LOCAL ASSN OF S.S.GREEN LOCAL E.A.- WAYNEGREEN LOCAL T.A.- SCIOTOGREENVILLE E. A.GROVEPORT-MADISON E.A.GUERNSEY NOBLE E.A.HAMILTON C.T.A.- BUTLERHAMILTON CO. E.A.HAMILTON LOCAL E.A.HARDIN HOUSTON E. A.HARDIN NORTHERN E. A.HARRISON HILLS T.A.HEATH E. A.HEATH ED'L S.S.A.HICKSVILLE E. A.HIGHLAND E. A.- MEDINAHIGHLAND E. A.- MORROWHIGHLAND SUPPORT STAFFHILLIARD E.A.HILLSBORO E.A.HILLSDALE E.A.HOCKING TECH COLLHOCKING TECH SSPHOLGATE T.A.HOPEWELL E. A.HOPEWELL LOUDON E.A.HOWLAND C.T.A.HUBBARD E.A.HUBER HEIGHTS E.A.HUDSON E. A.HUNTINGTON LOCAL E.A.HURON CLASSIFIED E.A.HURON E.A.INDEPENDENCE CLS EMP ASSNINDEPENDENCE E. A.INDIAN CREEK E. A.INDIAN LAKE A C EINDIAN LAKE E. A.INDIAN VALLEY T.A.IRONTON E. A.IRONTON S.S.A.JACKSON CITY E. A.JACKSON CLASSIFIED PERS ASSNJACKSON MEMORIAL E. A.JEFFERSON AREA T.A.JEFFERSON CO J.V.S. T.A.JEFFERSON TOWNSHIP E.A.JOHNSTOWN E. A.JONATHAN ALDER E. A.KALIDA E.A.KENSTON E. A.KENTON E. A.KETTERING E.A.KEYSTONE LOC E AKINGS E.A.KIRTLAND E. A.KNOX COUNTY CAREER CENTERKNOX NEW HOPE CTR. E.A.LABRAE T. A.LAKE E. A.- WOODLAKELAND FACULTY ASSNLAKE LOC E. A.- STARKLAKEVIEW SCHOOL SUPT ASSNLAKEVIEW T. A.LAKEWOOD CLASSIFIEDLAKEWOOD T.A.- CUYAHOGALAKEWOOD T.A.- LICKINGLAKOTA E.A.- BUTLERLAKOTA E.A.- SANDUSKYLAKOTA S.S.A.- BUTLERLANCASTER E.A.LANCASTER S.S.A.LAWRENCE CO. VOC T.A.L E A D DLEBANON E.A.LEETONIA E. A.LEIPSIC E.A.LEXINGTON S.S.A.LEXINGTON T. A.LIBERTY ASSN OF SCH EMPLLIBERTY CENTER C.T.A.LIBERTY UNION THURSTON E.A.LICKING HEIGHTS E. A.LICKING HEIGHTS ESP ASSNLICKING VALLEY E.A.LIMA E.A.LINCOLNVIEW LOCAL E.A.LISBON E.A.LITTLE MIAMI T.A.LOCKLAND E. A.LOGAN E. A.LOGAN ELM C.T.A.LONDON E. A.LORAIN ASSN CLASSIFIED EMPLORAIN COUNTY JVS T.A.LORAIN E. A.LOUDONVILLE PERRYSVLE E.A.LOUISVILLE E. A.LOVELAND E. A.LOWELLVILLE E.A.LUCAS T. A.MADISON E. A.- BUTLERMADISON E.A.- LAKEMADISON LOC E A- RICHLANDMADISON PLAINS E. A.MAD RIVER E.A.MAHONING CO. CTC CLSFDMAHONING CO CAREER AND TECH CTRMALVERN E.A.MANCHESTER E.A.MANCHESTER OHIO RIVERMANSFIELD SCHL EMPL ANMAPLE HTS. T.A.MAPLE ORGANIZ. SUPPORT TEAMMAPLETON T. A.MAPLEWOOD CAREER CTR E.A.MAPLEWOOD E.A.MARGARETTA T. A.MARIETTA E.A.MARIMOR E.A.MARION E. A. - MARIONMARION LOC E. A. - MERCERMARLINGTON E. A.MARTINS FERRY E.A.MARYSVILLE E. A.MASON E. A.MASSILLON E. A.MATHEWS E.A.MAUMEE E. A.MAYFIELD A. OF S.P.MAYFIELD E.A.MAYSVILLE CLASSIFIED EAMAYSVILLE E. A.MCCOMB T.E.A.MCDONALD E. A.M E A D DMECHANICSBURG E. A.MEDINA CITY SCHLS PSYCHOLOGISTSMEDINA CITY T. A.MEDINA CO ACHVMT CENTER E AMEDINA CO VOC. CTRMEIGS LOCAL T. A.MENTOR CLASSIFIED EMPLOYEESMENTOR T. A.METZENBAUM E. A.MIAMI EAST A.S.P.MIAMI EAST E. A.MIAMISBURG C.T.A.MIAMI TRACE E.A.MIAMI TRACE NON-CERT E.A.MIDDLETOWN CLASSI E.A.MIDDLETOWN T.A.MIDD-ROE EMPLOYEES UNIONMID EAST E.A.MILFORD CLASS. EMP. A.MILFORD E. A.MILLCREEK W UNITY E. A.MILLER-CTY-NEW CLEVELAND EAMILTON UNION E. A.MINERVA LOCAL E.A.MINFORD E. A.MINSTER T. A.MISSISSINAWA VAL T. A.MOGADORE E.A.MOGADORE E.S.A.MOHAWK E. A.MONROE COUNTY E.A.MONROE EDUCATION ASSNMONROEVILLE T. A.MONTPELIER E.A.MORGAN LOC. E.A.MT GILEAD T. A.MT HEALTHY CLSFD EAMT HEALTHY T. A.MT VERNON E. A.NAPOLEON FACULTY A.NATIONAL TRAIL E. A.NELSONVILLE YORK E. A.NEWARK T. A.NEW BREMEN T. A.NEWBURY E.A.NEWCOMERSTOWN CLASSIFIEDNEWCOMERSTOWN T.A.NEW LONDON E.A.NEW MIAMI E.A.NEW PHILADELPHIA E.A.NEW RIEGEL E. A.NEWTON FALLS A.C.E.NEWTON T.A.NILES E.A.NOBLE LOCAL C.T.A.NOBLE LOCAL SUPPORT ASSNNORDONIA HILLS E. A.NORTH BALTIMORE E. A.NORTH CANTON CLASS. EMP.NORTH CANTON E. A.NORTH CENTRAL E A - WILLAMSNORTH COLLEGE HILL E.A.NORTHEASTERN LOCAL E.A.NORTHEASTERN LOCAL T.A.NORTHEASTERN LOC A OF S.E.NORTHERN LOCAL E.A.NORTH FORK E. A.NORTHMONT DIST E.A.NORTH OLMSTED E. A.NORTHRIDGE E. A.- LICKINGNORTHRIDGE T A-MONTGOMERYNORTH ROYALTON E. A.NORTH UNION E.A.NORTHWESTERN A OF SCH EMPLNORTHWESTERN LOC E.A.NORTHWESTERN T A - CLARKNORTHWEST LOCAL E.A.NORTHWEST ST COM COLNORTHWEST T. A. - STARKNORTHWOOD LOCAL E.A.NORTHWOOD LOCAL SCHOOLS S ANORTON C.T.A.NORWALK T. A.NORWAYNE E.A.NORWAYNE E.S.P. ASSNNORWOOD T. A.NW ASSOCIATION OF EDUCATORSOAK HARBOR E.A.OAK HILLS E.A.OAK HILL UNION LOCAL E.A.OAKWOOD T.A.OBERLIN OHIO E. A.OEA-ROHIO VALLEY E.A.OLD FORT LOC E. A.OLENTANGY TEACHERS ASSNOLMSTED FALLS E.A.ORANGE TCHRS ASSNOTSEGO E. A.OTTAWA GLANDORF C.T.A.OTTAWA HILLS E. A.OTTAWA HILLS SUPPORT ASSNOTTOVILLE LOCAL E.A.PAINESVILLE CITY T. A.PAINT VALLEY LOC E.A.PANDORA GILBOA E. A.PARKWAY E. A.PARMA E. A.PATRICK HENRY E. A.PAULDING E. A.PENTA CAREER CENTER E. A.PERKINS E. A.PERRY ASSN OF SUPPORT STAFFPERRY C T A - LAKE COPERRY C T A - STARK COPERRY E. A. - ALLENPERRYSBURG E. A.PICKAWAY ROSS T.A.PICKERINGTON E.A.PICKERINGTON S.S.A.PIKE DELTA YORK E.A.PIKETON-SCIOTO E.A.PIQUA E. A.PLAIN LOC E. A. - FRANKLINPLAIN LOC T. A. - STARKPLEASANT A OF TPLYMOUTH E. A.POLAND E. A.POLARIS E. A.PORTAGE CO EDUCATORS FOR THE DDPORTAGE LAKES E. A.PORTSMOUTH CITY T. A.PREBLE-SHAWNEE LOCAL E.A.PRINCETON A. C. E.PUTNAM COUNTY E. A.PYMATUNING VALLEY E. A.RAVENNA E. A.READING E.A.REVERE E.A.REYNOLDSBURG E.A.REYNOLDSBURG S.S.A.RICHMOND HEIGHTS E.A.RIDGEDALE T. A.RIDGEMONT E.A.RIDGEWOOD E. A.RIPLEY-UNION-LEWIS E.A.RITTMAN E. A.RIVERDALE E. A.RIVERSIDE LOCAL E.A.RIVER VALLEY EMPLOYEES ASSNRIVER VALLEY T. A.RIVER VIEW E. A.ROBERT BYCROFT E.A.ROCK HILL E. A.ROCKY RIVER T. A.ROLLING HILLS E.A.ROOTSTOWN E. A.ROSS E.A.ROSSFORD A.C.T.RUSSIA E.A.S.C.O.P.E.SALEM E. A.SANDUSKY E.A.SANDY VALLEY E. A.SCIOTO CO CAREER TECH CTR T ASEBRING LOC E. A.SENECA EAST E. A.SHADYSIDE E. A.SHAWNEE CLASSIFIED EMP ASSNSHAWNEE E. A. - ALLENSHAWNEE E.A.- SCIOTO CO.SHEFFIELD-SHEFF LAKE T ASHEF-SHEFFIELD LAKE CLSFD E.A.SHELBY A. OF S.S.SHELBY E. A.SIDNEY E. A.SOUTH CENTRAL E. A.SOUTHEASTERN LOCAL E. A.SOUTHEASTERN LOCAL ESPSOUTHEASTERN LOCAL T ASOUTHEAST LOCAL DISTRICT TASOUTHEAST LOCAL E A - WAYNESOUTHEAST S.S.P. ASSNSOUTHERN HILLS J.V.S. T.A.SOUTHERN LOC E. A. - MEIGSSOUTHERN LOC E. A. - PERRYSOUTHERN LOC T.A. -COLUMBIANASOUTHERN STATE E.A.SOUTHINGTON E. A.SOUTH POINT A.C.T.SOUTH RANGE E. A.SOUTH-WESTERN E.A.SOUTHWEST LICKING E. A.SOUTHWEST LOC. C.T.A.SPENCERVILLE E. A.SPRINGBORO CLASS. EMPL.SPRINGBORO E. A.SPRINGFIELD E.A. - CLARKSPRINGFIELD E.A. - LUCASSPRINGFIELD E.S.P - SEUSSSPRINGFIELD LOCAL A.C.T.SPRINGFIELD LOCAL C.T.A.STARK AREA VOC. EDUCTRSSTARK CO EDUC PROF TRAINERSSTARK CO M.R.D.D. S.S.A.ST BERNARD-ELMWOOD PLC E AST CLAIRSVILLE E.A.STEUBENVILLE E. A.ST MARYS E.A.STOW MUNROE FALLS CLASS E ASTOW T. A.STREETSBORO E. A.STREETSBORO S.S.P.A.STRONGSVILLE E. A.STRUTHERS E. A.STRYKER E. A.SUGARCREEK E. A.SUGARCREEK LOCAL ASSN OF SPSWANTON E. A.SWANTON S.S. ASSNSWITZERLAND OF OHIO E. A.SYCAMORE E. A.SYLVANIA E.A.SYMMES VALLEY E. A.T. A. OF CENTRAL LOCT. A. OF LUCAS CO SCHOOLST. A. OF WASHINGTON LOCTALAWANDA CLASSIFIED S.A.TALAWANDA E. A.TALLMADGE TEACHERS ASSNTCHRS ORGN WEST RESVTEAYS VALLEY E. A.TECUMSEH E.A.THREE RIVERS A. OF S.S.P.THREE RIVERS E. A.TIFFIN E. A.TIPP CITY E.A.TOLLES E.A.TORONTO E. A.TRI-COUNTY NORTH E.A.TRI-COUNTY T. A.TRIMBLE LOC TEACHERS ASSNTRI-RIVERS E.A.TRI-VALLEY E. A.TRI-VILLAGE E. A.TRIWAY E. A.TROTWOOD MADISON E. A.TROY CITY E. A.TROY CITY S.S.A.TRUMBULL CAREER & TECH E.A.TRUMBULL CO BOARD CLSFD S ATRUMBULL CO BOARD PROF S.A.TUSCARAWAS VLY T. A.TUSLAW C.T.A.TWINSBURG E. A.TWINSBURG S.S. OEA-NEATWIN VALLEY A.C.T.UNION LOCAL E.A.UNION SCIOTO E. A.UNIOTO SUPPORT ASSNUNITED E. A.UNITED RIVERSIDE E.A.UPPER ARLINGTON E. A.UPPER SANDUSKY E. A.UPPER SANDUSKY S.S.UPPER SCIOTO VLY T. A.URBANA A.C.T.VALLEY T. A.VALLEY VIEW C.T.A.VAN BUREN E. A.VANDALIA BUTLER E.A.VERMILION T. A.VERSAILLES E. A.VINTON LOC T. A.WADSWORTH E. A.WADSWORTH SUPPORT STAFFWALNUT TWP E AWAPAKONETA CLASSIFIED ASSNWAPAKONETA E. A.WARREN E. A. - TRUMBULLWARREN LOC. E. A.WARREN SECRETARIAL ASSN.WARRENSVILLE E.A.WASHINGTON CENTERVILLE LBRY S AWASHINGTON CO CAR CNTR T.A.WASHINGTON E. A. - FAYETTEWASHINGTON LOCAL C.T.A.WATERLOO E. A.WAUSEON E. A.WAVERLY C.T.A.WAYNE COUNTY J.V.S. E.A.WAYNESFIELD-GOSHEN E.A.WAYNESVILLE E.A.WAYNESVILLE NON CERT E.A.WAYNE TRACE E.A.WEAVER E.A.WEAVER WORKSHOP SUPT ASSNWELLINGTON E. A.WELLINGTON S.S.P.WELLSTON T. A.WELLSVILLE T.A.WEST BRANCH CLSFD EMP ASSNWEST BRANCH E. A.WEST CARROLLTON CLSFD E.A.WEST CARROLLTON E. A.WEST CLERMONT E.A.WEST CLERMONT HOPEWESTERN BROWN E.A.WESTERN BROWN SCH EMP ORGWESTERN LOCAL E.A.WESTERN RESERVE E.A.WESTERVILLE E. A.WESTERVILLE EDUCATION S S AWESTFALL E. A.WEST GEAUGA E. A.WEST JEFFERSON E. A.WESTLAKE T. A.WEST LIBERTY SALEM E. A.WEST MUSKINGUM E. A.WEST MUSKINGUM SUPPORT ASSNWHEELERSBURG E. A.WHITEHALL E. A.WICKLIFFE E. A.WILLARD E.A.WILLIAMSBURG E. A.WILLOUGHBY-EASTLAKE CLSFDWILLOUGHBY-EASTLAKE T. A.WILMINGTON E.A.WINDHAM T. A.WINTON WOODS T.A.WOLF CREEK LOCAL E. A.WOOD LANE E.A.WOODMORE E. A.WOODRIDGE E. A.WOOSTER E. A.WORTHINGTON CLSFD ASSNWORTHINGTON E. A.WYNFORD E.A.WYOMING E. A.XENIA CAFETERIA STAFF ASSNXENIA E. A.XENIA EDUCATION SUPT PROF.YELLOW SPRINGS E. A.YOUNGSTOWN E. A.YSU-ACEYSU A OF PROF ADMIN STAFFYSU CHAPTER OF OEAZANESVILLE E. A.ZANE TRACE E. A.ZANE TRACE S.S.P. ASSN.Work Location(Required)Member Type(Required)Professional Pre K-12ESPStudentRetiredHiger EducationMember Status(Required)Current memberFormer memberNon-memberNot applicablePosition(Required)SubjectLocal Union RolePresident, Vice President, TreasurerAssociation RepActive, but not elected office holderNot an active memberUnknownCONVERSATIONType(1) Leader, would join/remain member(2) Supporter, would join/remain member(3) Undecided(4) Opposed, would not join/remain memberInterests Professional Development/Networking Classroom/Job Resources Anti-privatization/Outsourcing/For Profit Education Public Relations/Communications Lobbying/Legislation Retirement Bargaining Member Discounts Leadership or CB Training Other OtherOpinions (+)OEA/Local helps protect their rights (+)OEA/Local is a good advocate for public education (+)OEA/Local is a good value for the money (+)OEA/Local made a difference in their career (+)NEAMB is the most important benefit of OEA/Local (-)They don’t have a voice in OEA/Local decisions (-)Dues are too high (-)OEA/Education is too political (-)Not enough communication from OEA/Local Relationships of noteWhat are his/her interests? Values? What motivates this person? Why?Who does the member identify with as their union (NEA, OEA, local)? Opinions regarding their local. Opinions regarding OEA.MEMBER DISCUSSION REPORTTalents, background, networks and/or resources to offer their organizationWhat brings joy and what brings frustration in his/her work?What could the Union do to make work life better and what is he/she willing to do to make that happen?Important things learned(Required)Follow-up items due to memberDue Date MM slash DD slash YYYY ACTIONABLE RESULTSSigned commitment card?YesNoNot applicableJoined organization?YesNoCurrent memberNot applicableSigned petition?YesNoNot applicableIdentified as future potential leader?YesNoNot applicable Δ
