Informal Educator Professional Learning Program Application

If you have any questions, please contact Lindzy Bivings at lbivings@calacademy.org

Question Title

1. Please fill out the following:

Name:

Organization:

Title/ Position:

Address:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

Question Title

2. If applying with teammates, who are they?
(Teams of 2 or more receive a $50 discount per person)

Question Title

3. Please mark the program(s) that you would like to sign up for:
(if you are an Academy Staff Member or Volunteer, please check the "scholarship" boxes)

$175 Individual Registration - Learning, Reflections & Science (Oct. 1 - Nov. 19, 2014)

$125 Teammate Registration - Learning, Reflections & Science (Oct. 1 - Nov. 19, 2014)

Scholarship - Learning, Reflections & Science (Oct. 1 - Nov. 19, 2014)

$175 Individual Registration - Conservation & Sustainability Education (Jan. 14 - March 18, 2015)

$125 Teammate Registration - Conservation & Sustainability Education (Jan. 14 - March 18, 2015)

Scholarship - Conservation & Sustainability Education (Jan. 14 - March 18, 2015)

Question Title

4. Are you able to attend all of the sessions in the program(s) you have selected?

Question Title

5. What type of organization do you work for?
(select all that apply)

Natural History Museum

Aquarium

Zoo

Science Center

After School / Summer Camp Program

Outdoor Education Program

Conservation Organization

Nature Center

Other (please specify)

Question Title

6. What types of audiences do you normally work with when teaching?
(select all that apply)

Teachers

Informal Educators

Adults (not associated with education groups)

Families

High-School Age Youth

Middle School Age Youth

Elementary School Age Youth

Preschool Age Youth

Other (please specify)

Question Title

7. What format(s) do your programs/ activities normally follow?

Gallery Tours

Cart Based Activities

Drop-In Activities

Pre- Registered Groups (i.e. school groups, etc)

Web-Based Activities

Classroom/ Lab Based Programs

Outdoor/ Field Based Activities

Auditorium

Lectures

Other (please specify)

Question Title

8. About how many years have you been in an educator role?

6 +

Question Title

9. What are you most interested in gaining from this professional learning program?

Thanks for your application- we will be in touch soon! If you have any questions, please contact Lindzy Bivings at lbivings@calacademy.org

Question Title

* 1. Please fill out the following:

Question Title

* 2. If applying with teammates, who are they?(Teams of 2 or more receive a $50 discount per person)

Question Title

* 3. Please mark the program(s) that you would like to sign up for:(if you are an Academy Staff Member or Volunteer, please check the "scholarship" boxes)

Question Title

* 4. Are you able to attend all of the sessions in the program(s) you have selected?

Question Title

* 5. What type of organization do you work for? (select all that apply)

Question Title

* 6. What types of audiences do you normally work with when teaching? (select all that apply)

Question Title

* 7. What format(s) do your programs/ activities normally follow?

Question Title

* 8. About how many years have you been in an educator role?

Question Title

* 9. What are you most interested in gaining from this professional learning program?

1. Please fill out the following:

2. If applying with teammates, who are they?
(Teams of 2 or more receive a $50 discount per person)

3. Please mark the program(s) that you would like to sign up for:
(if you are an Academy Staff Member or Volunteer, please check the "scholarship" boxes)

4. Are you able to attend all of the sessions in the program(s) you have selected?

5. What type of organization do you work for?
(select all that apply)

6. What types of audiences do you normally work with when teaching?
(select all that apply)

7. What format(s) do your programs/ activities normally follow?

8. About how many years have you been in an educator role?

9. What are you most interested in gaining from this professional learning program?