History Day Urban Educator Conference Application: Saturday, October 3

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* 1. About You:

Name:

Email:

Grade(s) Taught:

Subject Taught:

Number of Years You have Worked with History Day:

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* 2. About Your School

Name of School:

City:

School District:

Percentage of Students on Free and Reduced Lunch:

How does your school work with History Day? (For example, full class project, honors students, after-school elective, etc.)

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* 3. Are you applying as an individual teacher from your school or as a team with other teachers?

Individual

Team

If you answered "Team" please list other members:

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* 4. What is the biggest challenge that you face as an educator in working with History Day in your school?

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* 5. What is the biggest challenge that your students face to completing a History Day project?

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* 6. What do you feel is going to be the most important benefit of attending this workshop?

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* 7. What topic would you most like to see covered at this workshop, which may or may not have been listed on the tentative agenda?

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* 8. If selected, are you willing to provide your home mailing address and social security number to the Minnesota Historical Society in order to receive the $100 stipend for successful completion of the conference.

Yes

No

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* 9. Do you have any scheduling conflicts that would prevent you from being at the full day of the conference, approximately 8:30 AM 0 4:00 PM. If so, please describe below. Please keep in mind that there are a limited number of spots and stipends available.

I am able to attend the full day of the conference.

I am able to attend a portion of the day. My availability is listed below.

Please describe any limits to your availability.