* 1. Thank you for your interest in STEMersion. Please fill out the application below.

* 2. As a participating teacher I understand that I will: (check Y/N)

- Attend 5 days of professional development June 26th -June 30th 2017 (8:30-4:30)
- Meaningfully contribute to group discussions and on-site activities to maximize my learning and the learning experience of colleagues
- Develop a project or lesson plan to showcase how I will implement the knowledge gained from STEMersion in my classes.
- Sign a release to allow my picture/video images from STEMersion to be used in future promotion materials
- Participate in one (1 hour) webinar in Fall 2017 to update participating colleagues on my implementation
- Receive $600 stipend for participating in the program
- Receive transportation to/from work sites Monday-Friday, lunch provided daily

* 3. Are you interested in receiving college graduate credits from your participation in STEMersion?

* 4. I believe this experience will help me increase student learning because: (Please keep within 200 words)

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