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Floyd County School System
Ford PAS Mini-Institute:June 7-8, 2010
Location: Rome, Georgia
Please complete this online registration by May 21, 2010.
Answers are required for all fields with an asterick (*) next to it.
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1
. Please complete your contact information.
Please complete your contact information.
First Name
Last Name
Title / Position
Organization / School Affiliation
Work Address
City State
Zip Code
Phone (please enter in xxx-xxx-xxxx format)
E-mail
Re-enter e-mail
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2
. May we include your contact information above on a contact list for the participants attending this mini-insitute?
May we include your contact information above on a contact list for the participants attending this mini-insitute?
Yes
No
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3
. Do you have teaching experience?
Yes
No
Do you have teaching experience?
Other (please specify)
4
. If you answered "Yes" to question 3, how many years of teaching experience do you have?
If you answered "Yes" to question 3, how many years of teaching experience do you have?
5
. If you answered yes to question 3, which subjects have you taught and/or are currently teaching?
If you answered yes to question 3, which subjects have you taught and/or are currently teaching?
6
. If you answered yes to question 3, what grade levels have you taught or are currently teaching? Please check all that apply.
If you answered yes to question 3, what grade levels have you taught or are currently teaching? Please check all that apply.
Middle School
9th
10th
11th
12th
College/University
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7
. What do you hope to learn from this Ford PAS Professional Development Mini-Institue?
What do you hope to learn from this Ford PAS Professional Development Mini-Institue?
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8
. How did you find out about this Ford PAS Professional Development opportunity?
How did you find out about this Ford PAS Professional Development opportunity?
A peer or colleague told me about it
I saw it on the Georgia Career Academies website
I received an invitation to attend from TCSG
I saw it in the Georgia Career Academy Network's newsletter
I saw it on the Ford PAS website
I saw it on the Ford NGLC website
Other (please specify)
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