Engaging Congress Workshop March 2018

Personal Information

25% of survey complete.

Thank you for taking the time to register for the Engaging Congress digital gaming workshop offered by the Indiana University Center on Representative Government. This workshop is most appropriate for middle and high school teachers or administrative staff.

This FREE workshop is scheduled for Friday, March 16, 2018 from 9:00 am to 3:00 pm on the IU Bloomington campus. Deadline for registration is Monday, March 5, 2018.

Confirmation emails will be sent within three days of registration.

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* 1. Please complete the following information:

First Name: *

Last Name: *

Home Address: *

Address 2:

City/Town: *

State: *

ZIP: *

U.S Congressional District where you live or teach (http://www.house.gov/representatives/find/) *

Email Address you check frequently: *

CELL Phone Number: *

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* 2. Please fill out your school information.

School Name: *

Name of Principal: *

Address: *

Address 2:

City/Town: *

ZIP: *

County:

Your School Email Address:

School Phone Number:

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* 3. What grades are you currently teaching?

5-8

9-12

Pre-service teacher/student

Media Specialist

Technology

Administrator/Curriculum/Guidance

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* 4. What subjects do you teach or expect to teach?

5-8 Social Studies

9-12 US Government or History (includes AP, Honors, Dual Credit, etc.)

9-12 Economics, Geography, World History, etc.

9-12 English Language Arts

Not in a classroom

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* 5. On average, how many students do you teach per semester?

0-30

30-60

60-90

90-120

120-150

150 or more

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* 6. How many years have you been an educator?

0-5

6-10

11-20

20 or more

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* 7. We will provide substitute reimbursement for the first 20 participants.

The maximum payment is $75. Participants must complete the entire workshop to qualify for this benefit.

Will you request substitute reimbursement?

Yes

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* 1. Please complete the following information:

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* 2. Please fill out your school information.

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* 3. What grades are you currently teaching?

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* 4. What subjects do you teach or expect to teach?

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* 5. On average, how many students do you teach per semester?

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* 6. How many years have you been an educator?

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* 7. We will provide substitute reimbursement for the first 20 participants. The maximum payment is $75. Participants must complete the entire workshop to qualify for this benefit.Will you request substitute reimbursement?

* 7. We will provide substitute reimbursement for the first 20 participants.

The maximum payment is $75. Participants must complete the entire workshop to qualify for this benefit.

Will you request substitute reimbursement?