Registration: Indiana History July 2016

Personal Information

25% of survey complete.

Thank you for taking the time to register for a TPS workshop offered by the Indiana University Center on Representative Government. Please answer the following questions to the best of your ability. All information will be confidential and your personal information will not be shared.

Deadline for registration is July 6, 2016
Attendees will receive a confirmation email within a week of their registration submission.

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* 1. Please fill out your personal information below.

First Name: *

Last Name: *

Home Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Congressional District (http://www.house.gov/representatives/find/) *

Email Address that you frequently check in the summer: *

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?

K-4

5-8

9-12

Media Specialist

Technology

Administrator/Guidance

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* 4. What subjects do you currently teach?

K-4

5-8 Social Studies

5-8 English Language Arts

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 taught at this school?

0-5

6-10

11-20

21 or more

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

0-5

6-10

11-20

20 or more

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* 8. We are sometimes able to negotiate competitive hotel rates for those who live more than an hour's drive from the host location. Participants pay the hotel directly. Would you like information about a host hotel?

I DO NOT want hotel information

I WOULD LIKE hotel information

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* 9. Depending on funding, we may be able to provide substitute reimbursement. The maximum payment is $75 per school day. Participants must complete the entire workshop to qualify for this benefit.

Will you be teaching summer school and eligible for substitute reimbursement?

Yes

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* 1. Please fill out your personal information below.

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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 currently 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 taught at this school?

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

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* 8. We are sometimes able to negotiate competitive hotel rates for those who live more than an hour's drive from the host location. Participants pay the hotel directly. Would you like information about a host hotel?

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* 9. Depending on funding, we may be able to provide substitute reimbursement. The maximum payment is $75 per school day. Participants must complete the entire workshop to qualify for this benefit.Will you be teaching summer school and eligible for substitute reimbursement?

* 9. Depending on funding, we may be able to provide substitute reimbursement. The maximum payment is $75 per school day. Participants must complete the entire workshop to qualify for this benefit.

Will you be teaching summer school and eligible for substitute reimbursement?