2015
Educator Enrichment Workshop Registration

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* 1. Participate Information

Name: *

Home Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 2. School Information:

School *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 3. School District | School County:

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* 4. Title 1 School:

Yes

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* 5. Percent Free/Reduced Lunch:

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* 6. Approximate Percent Minority:

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* 7. Have you previously participated in Sanford PROMISE Programming? If yes, please explain:

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* 8. Number of years as a professional educator?

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* 9. Courses for 2015/2016 |Grade Levels | Number of Students:

Courses

Grade levels

Number of students

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* 10. Current Teaching License (please list each state):

State

Expiration Date

Primary Area

Additional State

Expiration Date

Primary Area

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* 11. List your three most relevant awarded professional degrees:

Institution

Degree(s)

Date

Institution

Degree(s)

Date

Institution

Degree(s)

Date

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* 12. List the three most recent specialty workshops, conferences, or training sessions you have attended:

Workshop

Area of Focus

Date

Workshop

Area of Focus

Date

Workshop

Area of Focus

Date

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* 13. What are your expectations for this workshop?

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* 14. One letter of support from an administrator is required for participation. Please identify the individual that will provide this support letter:

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* 15. Continuing education units and/or graduate credits are available through this workshop (one graduate credit; $40). Do you anticipate taking this workshop for credit? If taking the workshop for graduate credit, full attendance is required and a follow-up assignment is due within two weeks of the workshop.

CEU

Graduate

No Credit

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* 16. Which session are you registering for:

Diagnosing Disease (Grades 6-10): Investigate a series of classroom tested methods utilized to diagnose and predict inheritance of genetic disease. (July 20 and 21)

Elementary Inquires (Grades K-6): Discover fun, meaningful standards based life science projects for next year; including incorporation of classroom “critters”. (July 23 and 24)

Personal Genetics (Grades 9-12): Uncover SNPs, VNTRs, and other unique aspects of your own genetics with hands-on modules for advanced science courses. (July 28-30)

Admission will be made on a rolling basis, all registrants will be notified of their selection status and provided workshop schedules by May 15th.

Support letter should be sent by the author of the letter either via email or mail to:

SanfordOutreach@sanfordhealth.org

or

Sanford Research
Attn: Tamara Ledeboer
2301 E. 60th Street North
Sioux Falls, SD 57104