Informal Educator Professional Learning Program Application

If you have any questions, please contact Lindzy Bivings at lbivings@calacademy.org

Question Title

* 1. Please fill out the following:

Name:

Organization:

Title/ Position:

Address:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

Question Title

* 2. If applying with teammates, who are they?
(Teams of 2 or more receive a $50 discount per person)

Question Title

* 3. Please mark the program(s) that you would like to sign up for:
(if you are an Academy Staff Member or Volunteer, please check the "scholarship" boxes)

$175 Individual Registration - Learning, Reflections & Science (Oct. 1 - Nov. 19, 2014)

$125 Teammate Registration - Learning, Reflections & Science (Oct. 1 - Nov. 19, 2014)

Scholarship - Learning, Reflections & Science (Oct. 1 - Nov. 19, 2014)

$175 Individual Registration - Conservation & Sustainability Education (Jan. 14 - March 18, 2015)

$125 Teammate Registration - Conservation & Sustainability Education (Jan. 14 - March 18, 2015)

Scholarship - Conservation & Sustainability Education (Jan. 14 - March 18, 2015)

Question Title

* 4. Are you able to attend all of the sessions in the program(s) you have selected?

Question Title

* 5. What type of organization do you work for?
(select all that apply)

Natural History Museum

Aquarium

Zoo

Science Center

After School / Summer Camp Program

Outdoor Education Program

Conservation Organization

Nature Center

Other (please specify)

Question Title

* 6. What types of audiences do you normally work with when teaching?
(select all that apply)

Teachers

Informal Educators

Adults (not associated with education groups)

Families

High-School Age Youth

Middle School Age Youth

Elementary School Age Youth

Preschool Age Youth

Other (please specify)

Question Title

* 7. What format(s) do your programs/ activities normally follow?

Gallery Tours

Cart Based Activities

Drop-In Activities

Pre- Registered Groups (i.e. school groups, etc)

Web-Based Activities

Classroom/ Lab Based Programs

Outdoor/ Field Based Activities

Auditorium

Lectures

Other (please specify)

Question Title

* 8. About how many years have you been in an educator role?

6 +

Question Title

* 9. What are you most interested in gaining from this professional learning program?

Thanks for your application- we will be in touch soon! If you have any questions, please contact Lindzy Bivings at lbivings@calacademy.org

Question Title

* 1. Please fill out the following:

Question Title

* 2. If applying with teammates, who are they?(Teams of 2 or more receive a $50 discount per person)

Question Title

* 3. Please mark the program(s) that you would like to sign up for:(if you are an Academy Staff Member or Volunteer, please check the "scholarship" boxes)

Question Title

* 4. Are you able to attend all of the sessions in the program(s) you have selected?

Question Title

* 5. What type of organization do you work for? (select all that apply)

Question Title

* 6. What types of audiences do you normally work with when teaching? (select all that apply)

Question Title

* 7. What format(s) do your programs/ activities normally follow?

Question Title

* 8. About how many years have you been in an educator role?

Question Title

* 9. What are you most interested in gaining from this professional learning program?

* 2. If applying with teammates, who are they?
(Teams of 2 or more receive a $50 discount per person)

* 3. Please mark the program(s) that you would like to sign up for:
(if you are an Academy Staff Member or Volunteer, please check the "scholarship" boxes)

* 5. What type of organization do you work for?
(select all that apply)

* 6. What types of audiences do you normally work with when teaching?
(select all that apply)