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Teacher Workshop Application

Contact Information for Participating Teacher — Please fill in all fields
Title First Name M.I. Last Name  
Preferred Name or Nickname Gender  
 
School Name  
School Address
City State ZIP
School Phone Number School Fax Number ESC*
School Email Address  

*Educational Service Center -- Texas schools only.

Home Address
We will need to contact you during the summer months to alert you about important workshop-related information, or possible openings for teachers on waitlists. Please provide your summer contact info here.
Home Address
City State ZIP
Phone Number Email Address
Best Way to Contact You

Choose your overall best contact method (left column) and your preferred contact method for mail, phone and email (right column).

Mail: School Address
Home Address
Phone: School Telephone
Home Telephone
Email: School Email
Home Email
Rank Your Choices from Available Workshops
Workshop availability varies based on the volume of applications we receive and the credentials of the applicants.
Dates Workshop Grade Level
June 17-19 Comets! 6-12
June 21-24 Earth and Space Science ($750) 11-12
June 25-27 Explore Our Solar System I ($550) K-8
July 5-7 Worlds Beyond Our Solar System 7-12
July 8-10 MONET: Using a Remote Telescope (Scholarships for Texas teachers only.) 9-12
July 11-13 Explore Our Solar System II ($550) K-8
July 19-22 Formation of Planetary Systems 7-12

Please let us know your first, second, and third choice of workshop.
First Choice: 
Second Choice:

Third Choice:
School Demographics
This information is required by our funder.
Do you teach in a rural school? No Yes
Percent students of low socio-economic class:
Percent students of underrepresented minorities:
Dietary Restrictions
Do you have any special dietary restrictions? No Yes
If yes, please list your restrictions:
Background Information
Please take a minute to tell us about yourself so we can provide you with a meaningful experience. List the grade you currently teach first:
Grade Level:   Subject(s) Taught:   Years:
Grade Level:   Subject(s) Taught:   Years:
Grade Level:   Subject(s) Taught:   Years:

Teaching Certificate Areas


College/University Education
Undergraduate Institution:
City:   State:
Major:   Minor:   Degree & Year:
Graduate Institution(s):
City:   State:
Degree(s):   Major:   Year:
Professional Activities
1. List professional science organizations you belong to:
2. List any other science professional development programs you have attended.
3. Describe how participating in this workshop will benefit both you and your students. Please provide a thorough answer:
Click Submit below to enter your request. It may take several seconds for the submission process to complete. Once we have received all applications (soon after the
deadline date) you will be contacted regarding the status of your visit.
 



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Last Modified: October 29, 2009