Cleveland State University 2016 STEM Education Conference Registration for 5-8 and 9-12 Grade Levels

Dear CSU's 2016 STEM Education Conference Participants:

We look forward to hosting the 9th Annual STEM Education Conference on Wednesday, June 15, and Thursday, June 16, at Cleveland State University. The 1 1/2 day conference is free, breakfasts, lunch, and parking are provided, as well a Certificate of Completion for 7.5 C.E.U. hours.

We are excited to offer the opportunity to have you engage in during the day-and-a-half conference five (5) hands-on interactive STEM-related lessons and ideas for each of the 5-8 and 9-12 grade band levels.

The conference has the capacity for fifty-two (52) 5th-12th grade educators.

Below you will find the registration form for the 2016 STEM Education Conference.

YOUR REGISTRATION WILL BE CONFIRMED VIA EMAIL UPON RECEIPT OF THE $25 REFUNDABLE CHECK payable to
Cleveland State University (or simply CSU).

(I know it's another step, yet it has been proven that the mailed check shows intent followed by attendance the days of the conference! Thank you.)

Please mail via U.S. post by June 3rd.

(The sooner you mail in your check, the more likely you are to have a confirmed registration.)

Cleveland State University
STEM Education Conference
Math Department RT 1448
1860 E. 22nd Street
Cleveland, OH 44115

We will return your check to you at the end of the Conference.

Thank you and we look forward to seeing you at 2016 STEM Education Conference sponsored by the National Science Foundation and Cleveland State University. (Check mailing address will be available again after survey is completed.)

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* 1. Please provide:

First Name

Last Name

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* 2. Street Address (i.e., 2020 Euclid Ave.)

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* 3. City

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* 4. State

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* 5. Zip Code

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* 6. Cell Phone (i.e., 999-555-0123)

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* 7. Home or Work Phone (i.e., 999-555-0123)

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* 8. Best Contact Email Address (i.e. johnsmith@csuohio.edu)

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* 9. Second Best Contact Email Address

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* 10. Full name of school where you will be employed during the 2016-2017 academic year. The complete school name is important for your name tag and CSUTeach Mentor Program information.

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* 11. Telephone number of the school where you will be employed during the 2016-2017 academic year.

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* 12. Full Name of School District (i.e., Cleveland Metropolitan School District, Maple Heights School District)

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* 13. Subject Area(s) and Grade Levels of Certification/Licensure

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* 14. Please list the grade level(s) and subject areas you are currently teaching. (i.e., 9th Algebra, 10th-12th Engineering)

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* 15. Please list the grade level(s) and subject areas you most likely will be teaching during the 2016-2017 academic year (i.e., 6th grade Science, 10th grade Geometry)

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* 16. For the breakout sessions, participants will be divided into 2 groups of maximum 26 educators. Please select the grade level band that best serves you.

If you find you are wait listed for your optimal choice of grade band level (you will know after you hit DONE at the end of the form) be sure to put your name on the Wait List. We will contact you immediately when there is a cancellation. Thank you for following these procedures.

5-8

9-12

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* 17. Please list any dietary restrictions which you would like us to be aware of for your lunch and breakfast. (i.e., vegan, vegetarian, gluten-free, no pork, etc.) We will do our best to accommodate you.