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* 1. Applicant name:

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* 2. School district:

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* 3. School name:

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* 4. School address:

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* 5. Grade level:

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* 6. Are you classified as a special education teacher?

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* 7. School phone:

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* 8. School email:

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* 9. Applicant phone number:

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* 10. Personal email:

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* 11. Do you prefer we contact you using your school email or your personal email address?

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* 12. How did you hear about the Autry Teacher Academy?

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* 13. Why do you want to participate in the Autry Teacher Academy?

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* 14. The purpose of the Autry Teacher Academy is to help talented teachers create engaging, powerful, and memorable project based learning units in the classroom. For five days in the summer, Academy participants work with historians, curators, archivists, master teachers, and other experts in their fields to help develop a project based unit plan for classroom implementation in the coming academic year. Teachers then share the results of this work at the Autry Social Action Symposium which takes place in May 2019.

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* 15. The theme that will drive this year’s academy is, “Champions of Change: Inspiring our Shared Future through Social Action.”  With this theme in mind, please answer the following questions:

Why do you believe this theme is important?

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* 16. How does this theme fit into your teaching philosophy?  Have you, or are you currently working on projects that connect with this theme?

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* 17. Do you believe that you can apply this theme in your classroom?  Please explain why.

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* 18. I agree to participate in each day of the Academy, July 9-13, 2018.

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* 19. I agree to participate in the Social Action Symposium in May 2019.

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* 20. I will create an original project based learning unit during the Academy and will implement that unit between September and April.

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* 21. I agree to participate in an Autry Classroom Curators partnership, which includes working with Autry education staff throughout the school year to help students create an exhibition to be showcased at the Autry or in the community.

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* 22. As a participant in the Autry Teacher Academy, you will create a project based learning unit, conduct research, synthesize information, craft compelling questions, create a long-term project plan, hone in on how to take community action, and much more.  In order for us to tailor the Academy to best suit your needs, please share with us the skills you believe you will need to build upon during the Academy.

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* 23. On a scale of 1-5, please rate your comfort level and familiarity with project based learning (1 being not at all, 5 being very familiar).

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* 24. Finalists will participate in a phone interview. All accepted applicants will be notified by February 2018.

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* 25. Please note that a completed 2018 Autry Teacher Academy application includes three components:

A. This SurveyMonkey application. 
B. A letter of recommendation from your principal.  Recommendation forms can be found on the Autry's website.  Please direct recommendation letters to outreach@theautry.org.
C. Please email a student centered lesson plan that you have created and used in your classroom to outreach@theautry.org.

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