PLEASE READ CAREFULLY!

TIP - This form may time out if left idle for an extended time. Feel free to look over the information needed and collect anything you do not have at hand before you begin your registration. Approx. completion time: 25 mim.
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The Shoals Chamber's Classroom to Careers workshop is 7 days on two consecutive weeks:

June 4 - 7 (T - F) and June 11 - 13 (T - Th).

This program is open to public, private and home school educators, administrators, youth workers, and community services who focus on youth career readiness & job placement.

A limited number of STIPENDS ($75 per full day) are available for educators who:
1) are ON A 9-MONTH (or flexible 10-month) CONTRACT,
2) are NOT ON REGULAR CONTRACT DURING THE EVENT DATES
3) are within the "target group" (middle & high school math & science teachers & counselors and administrators) and
4) have not been through the workshop before.
However, we reserve the right to offer stipends to other educators not on contract during the workshop, as funds are available.
Classroom to Careers' target audience is Educational Leaders / Administrators, TEAMS Teachers, Middle & High School Math & Science Teachers and Counselors. Priority will be given to The Shoals (NW Alabama) educators in these categories. However, others are welcome to apply and are accepted as space is available (and we almost always have space available).

The selection process may be competitive. Class size is limited to ~30.

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* 1. FIRST Name
(name you prefer to be called & for name tag)

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* 2. LAST Name

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* 3. School E-MAIL
- Please be SURE it is correct, as e-mail will be the primary mode of communication.
- Please be sure you CHECK  IT  REGULARLY.

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* 4. Alternate E-MAIL (Personal / SUMMER)
- Please be SURE it is correct, as e-mail will be the primary mode of communication.
- Please be sure you CHECK  IT  REGULARLY.

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* 5. School System
(if Private, Home School, New Grad or Other, state that or explain)

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* 6. School Name or Organization
(if New Grad or Other, please explain)

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* 7. School Phone (include area code)

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* 8. Cell Phone (include area code)

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* 9. Home Phone (include area code)

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* 10. School CITY

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* 11. School STATE

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* 12. School COUNTY

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* 13. Your HOME City, ST

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* 14. What is your T-shirt size?
(Men's sizes)

NOTE:  Sizes will be guaranteed for those who register before April 22.  After that, we'll do our best, but no guarantees.

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* 15. I am a:
(check all that apply)

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* 16. Which type of credential do you require?
NOTE - You CAN receive BOTH TEAMS credit and the PLU!
- You must attend everyday, all day to receive the PLU.
- You will be required to complete all the PLU requirements (presentation and share-out described next)
- You will be required to submit only the (1) hands-on, cross-curricular classroom project plan from the TEAMS requirements, but not the other three (3) lesson plans.

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* 17. Are you an alumnus of a previous Workforce Readiness Institute (now Classroom to Careers)?

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* 18. Date of Birth
Use this format: MM/DD/YYYY
(This is for the security clearance needed for tour at some facilities.)

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* 19. What is your Shoe Size?
Please indicate gender & size, i.e. "Ladies', 7" or "Men's, 10"
(This is for some industries which supply safety, steel-toe shoes for our tour)

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* 20. Are you committed to attend all 7 days of the Classroom to Careers (June 4 - 7 & 11 - 13)?

Select below ALL DAYS you CAN ATTEND.

We realize conflicts arise and we generally can allow you to miss "planned" days if needed, unless we have a waiting list, but please plan to attend all days.

You can let us know later if conflicts arise, but it's helpful for our scheduling purposes (transportation, meals, tour sizes, etc.) to know up-front if you know now of any days you will have to miss.

PLU Candidates - the AL SDE REQUIRES you to have 100% attendance, or "make up" any missed tours and CTE visits & submit a written summary.

TEAMS PD Candidates - your number of contact hours will be issued according to the actual time you attend.

Contact Hours Candidates - your number of contact hours will be issued according to the actual time you attend.

Stipend Candidates - your stipend will be adjusted according to the actual time you attend.

Alumni - You may use the ALUMNUS option and let us know once the schedule is set.

I commit to ATTEND on the following days:

PRE-SURVEY

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* 21. If you are a Teacher, what Subject(s) do you teach?
If you are an Administrator, Counselor or Other, please list in the comments box, what are your primary responsibilities / job duties?
(check ALL that apply)

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* 22. Which grade(s) do you serve, teach, counsel, lead within your school or system?
(check all that apply)

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* 23. Approximately how many students TOTAL do you serve, teach, counsel or lead EACH YEAR?

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* 24. How long have you been an educator in K-12 schools?

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* 25. From what college(s) did you graduate?

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* 26. What degree(s) did you earn?

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* 27. Seven days is a lot of time during your summer to commit to a professional development opportunity. We applaud you for your interest! And we are planning an exciting program for you that will benefit you and your students for years to come.

Tell us more about why you are interested in attending Classroom to Careers.
(check all that apply)

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* 28. What hands-on / eyes-on experience, if any, have you had with TECHNICAL  PROFESSIONS (i.e. those which require skills gained in career technical education, such as industrial, medical, agricultural, robotics / automation, etc.)?

None Extensive
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 29. Please explain your answer above about experience with Technical Professions.

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* 30. Tell us what you expect to gain from participating in the Shoals Chamber's Classroom to Careers and how you expect to use the information in your classroom, school or system.

CONTRACT  &  STIPEND  INFO

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* 31. I will be ON CONTRACT with the school system during early June (i.e. a 10- or 12-month contract).

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* 32. Because I will be ON CONTRACT, I understand that, if selected, I CANNOT receive a stipend.

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* 33. I am an ALUMNUS of Classroom to Careers (formerly the Workforce Readiness Institute).
If selected, I understand I WILL LIKELY NOT receive a STIPEND, depending on the number of new participants and stipend funds available.

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* 34. IF receiving a STIPEND, I understand I will be paid UP TO $75 per day, according to the ACTUAL TIME I attend the Classroom to Careers daily, recorded on my time sheet.
[Entire Daily Session, +/-8 hrs = $75]

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* 35. IF receiving a STIPEND, I understand that I will be REQUIRED to complete the Post-Event Survey AND other CONTACT HOURS-, TEAMS- or PLU-requirements, BY July 15 TO RECEIVE MY STIPEND.
(Requirement details are below.)

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* 36. IF receiving a STIPEND, to what address would you like your check sent?

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* 37. I understand that AFTER the event is over, my Post-Event Survey is completed AND all required work is submitted, it may take SEVERAL WEEKS TO RECEIVE MY STIPEND.

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* 38. Because seating is limited, I understand that my selection potentially prevents someone else from attending, IF there is a waiting list.

If selected to be in the class, I am FULLY  COMMITTED to attending each day, unless an emergency arises.

NOTE:  If you not fully committed, it does not disqualify you from participating, a long as there is not a waiting list.

MISCELLANEOUS

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* 39. Do you have any food allergies or medical issues we should know about? If so, please explain.

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* 40. Do you wear eye-glasses? 

NOTE:  NOT contacts, but regular eye-glasses.  This is so we will know what type of safety glasses you will need.

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* 41. In case of an emergency during the program, whom should we contact?

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* 42. How did you hear about the Classroom to Careers (formerly Workforce Readiness Institute)?
(check all that apply)

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* 43. Is there anything else you would like to tell us about you or your participation in the Shoals Chamber's Classroom to Careers program?

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