TEACHER INSTITUTE (2020 Focus: Sustainability)
(June 28-July 2, 2020)

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* 1. Contact Information (Personal)

Last Name

First Name

Home Address 1

Home Address 2

City/Town

State

ZIP

Country

Email Address

Phone Number

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* 2. Contact Information (School)

School District

School Name

School Address1

School Address2

City/Town

State

ZIP

Country

Email Address

Phone Number

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* 3. Grade Level Taught:

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* 4. Year Experience:

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* 5. Subjects Taught in Last 2 Years:

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* 6. If you have any formal training in materials science or engineering, please briefly describe:

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* 7. Please list your academic degree/s, including major and minor (if applicable):

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* 8. Please write a 100-word essay (may be less) explaining why you would like to attend this camp and what your expectations are:

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* 9. Please indicate the location (City, State and year) of the first teachers camp you attended.

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* 10. Indicate if you are currently teaching materials science class / or are planning to offer a new materials science class in your school, and when.

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* 11. Please provide your gender. (This is needed for housing; i.e., shared room.)

Male

Female

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* 12. Please provide any dietary restrictions.

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* 13. Please specify your ethnicity (This info is requested by some of government grants.)

White

Hispanic or Latino

Black or African American

Native American or American Indian

Asian / Pacific Islander

Other (please specify)

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* 14. Please provide name of your principal and contact information.

Name

School

Email Address

Phone Number