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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
Please provide your personal contact information so we can alert you about future teacher workshops.

Use school address (above) for home address (below)
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 25-29 The Age of the Milky Way
Submit application by February 15, 2008
9-12
July 6-10 Chandra: Stellar Evolution From Formation to Destruction
Submit application by February 15, 2008
9-12
July 20-22 Explore Our Solar System - $525
Submit application by May 1, 2008
K-8
July 28-30 Light and Optics
Submit application by February 15, 2008
6-12
August 3-6 Formation of Planetary Systems
Submit application by February 15, 2008
6-12

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:
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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