2020 Penn State Nano Teacher Workshop

Registration Form

Thank you for your interest in attending the 2020 Penn State Nanotechnology Teacher Workshop:

Sustainability in the Sciences & the Science of Sustainability

Please mark your calendar...

Date: Tuesday, April 21, 2020
Time: 8:00AM - 4:30PM
Location: Penn State University, N201 Millennium Science Complex, University Park, PA

Attendance is FREE to all participants. Lunch is included.

Space is limited, therefore a "wait-list" will be created once slots are filled.

Email confirmation indicating your attendance status will be sent within one week of your registration submission.

Note: The information requested below will be used for evaluation and reporting purposes, as well as program planning. Your responses are greatly appreciated - Thank you!

_____________________________________________________________________________________________

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* 1. Please provide your contact information below:

Note: This information will be used for name-tags, possible mailing of program materials, and direct communication if necessary to contact you. Please use your mailing address and type your name exactly as you would like to have it printed.

First Name:* *

Last Name:* *

Mailing Address Line 1: *

Address Line 2 (if needed):

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 2. If currently employed as a full time teacher, please write the name of your school.
Otherwise, please leave blank.

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* 3. If currently employed by a school district in any way, please write the name of your district.
Otherwise, please leave blank.

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* 4. PDE Number (if interested in receiving ACT 48 Credit; this credit is now offered for FREE)
Otherwise, please leave blank.

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* 5. Grade Levels: Which one of the following best describes the current grade level(s) of the students you teach?

Upper Elementary (Grades 4-6)

Middle School or Junior High (Grades 6-8)

High School (Grades 9-12)

Other (please describe):

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* 6. Educational Role: Which one of the following best describes your current position?

Classroom Teacher

Substitute Teacher

Home Schooler

Administrator/Supervisor

Outreach Provider

Curriculum Supervisor

Informal Educator

University Faculty/Staff

Other (please describe):

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* 7. Subject Areas: Which of the following best describes the subject area(s) that you teach?
(Choose all that apply.)

Astronomy

Biology

Chemistry

Computer Science

Earth Science

Engineering

Environmental Education

General Science

Mathematics

Physical Science

Physics

Social Studies/Geography

Space Science

Technology Education

Other (please specify)

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* 8. How did you hear about the 2020 Penn State sustainability-focused Nanotechnology Teacher Workshop opportunity?

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* 9. Have you attended a previous Nano Teacher Workshop with us in the past five years? (Yes or No)
If YES - Please briefly describe the way(s) in which you've tried to integrate past workshop materials and/or resources into your educational content.

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* 10. What is your primary reason for attending the 2020 Nano Teacher Workshop?

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* 11. At its conclusion, what would you like to have gained as a result of attending the 2020 Nano Teacher Workshop? (Please briefly describe.)

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* 12. Lunch will be provided. If you have any dietary restrictions, please briefly describe them here so that we can do our best to accommodate your needs. Otherwise, please leave blank.

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* 13. Please read and confirm your agreement to the following:
I understand that there is no fee to attend this workshop, but that available slots are limited and a wait list will be created once positions are filled. I also realize that program organizers need an accurate account of attendees for planning purposes. Therefore, if admitted to the program, I am committed to attending. If for some reason my circumstances change, I promise to inform program organizers immediately so that another person can be contacted to attend in my place.

I agree and will attend if admitted to the program.

I am not yet able to guarantee my attendance if admitted to the program.

Other (please explain):

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* 14. (Optional) This workshop is open and welcome to all STEM educators who work with grades 6 and up. For our reporting purposes, you are invited to provide the following information:
What is your gender?

Male

Female

I prefer not to report

Other (please specify)

Question Title

* 15. (Optional) This workshop is open and welcome to all STEM educators who work with grades 6 and up. For our reporting purposes, you are invited to provide the following information:
Which one of the following best describes your ethnicity?
(check all that apply)

Asian

Black or African American

Hispanic or Latinx

Native American or Alaskan Native

Pacific Islander

White or Caucasian

I prefer not to report

Other (please specify)

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* 16. Do you have any additional questions about the workshop? Do you need any accomodations?
If yes, please provide details here, or contact Kristin Dreyer at kad4@psu.edu.

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* 1. Please provide your contact information below:Note: This information will be used for name-tags, possible mailing of program materials, and direct communication if necessary to contact you. Please use your mailing address and type your name exactly as you would like to have it printed.

Question Title

* 2. If currently employed as a full time teacher, please write the name of your school. Otherwise, please leave blank.

Question Title

* 3. If currently employed by a school district in any way, please write the name of your district. Otherwise, please leave blank.

Question Title

* 4. PDE Number (if interested in receiving ACT 48 Credit; this credit is now offered for FREE)Otherwise, please leave blank.

Question Title

* 5. Grade Levels: Which one of the following best describes the current grade level(s) of the students you teach?

Question Title

* 6. Educational Role: Which one of the following best describes your current position?

Question Title

* 7. Subject Areas: Which of the following best describes the subject area(s) that you teach? (Choose all that apply.)

Question Title

* 8. How did you hear about the 2020 Penn State sustainability-focused Nanotechnology Teacher Workshop opportunity?

Question Title

* 9. Have you attended a previous Nano Teacher Workshop with us in the past five years? (Yes or No)If YES - Please briefly describe the way(s) in which you've tried to integrate past workshop materials and/or resources into your educational content.

Question Title

* 10. What is your primary reason for attending the 2020 Nano Teacher Workshop?

Question Title

* 11. At its conclusion, what would you like to have gained as a result of attending the 2020 Nano Teacher Workshop? (Please briefly describe.)

Question Title

* 12. Lunch will be provided. If you have any dietary restrictions, please briefly describe them here so that we can do our best to accommodate your needs. Otherwise, please leave blank.

Question Title

Question Title

* 14. (Optional) This workshop is open and welcome to all STEM educators who work with grades 6 and up. For our reporting purposes, you are invited to provide the following information:What is your gender?

Question Title

* 15. (Optional) This workshop is open and welcome to all STEM educators who work with grades 6 and up. For our reporting purposes, you are invited to provide the following information:Which one of the following best describes your ethnicity?(check all that apply)

Question Title

* 16. Do you have any additional questions about the workshop? Do you need any accomodations? If yes, please provide details here, or contact Kristin Dreyer at kad4@psu.edu.

* 1. Please provide your contact information below:

Note: This information will be used for name-tags, possible mailing of program materials, and direct communication if necessary to contact you. Please use your mailing address and type your name exactly as you would like to have it printed.

* 2. If currently employed as a full time teacher, please write the name of your school.
Otherwise, please leave blank.

* 3. If currently employed by a school district in any way, please write the name of your district.
Otherwise, please leave blank.

* 4. PDE Number (if interested in receiving ACT 48 Credit; this credit is now offered for FREE)
Otherwise, please leave blank.

* 7. Subject Areas: Which of the following best describes the subject area(s) that you teach?
(Choose all that apply.)

* 9. Have you attended a previous Nano Teacher Workshop with us in the past five years? (Yes or No)
If YES - Please briefly describe the way(s) in which you've tried to integrate past workshop materials and/or resources into your educational content.

* 14. (Optional) This workshop is open and welcome to all STEM educators who work with grades 6 and up. For our reporting purposes, you are invited to provide the following information:
What is your gender?

* 15. (Optional) This workshop is open and welcome to all STEM educators who work with grades 6 and up. For our reporting purposes, you are invited to provide the following information:
Which one of the following best describes your ethnicity?
(check all that apply)

* 16. Do you have any additional questions about the workshop? Do you need any accomodations?
If yes, please provide details here, or contact Kristin Dreyer at kad4@psu.edu.