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* 1. What is your last name?

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* 2. What is your first name?

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* 3. What is the name of your school?

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* 4. What grade level will you teach in 2017-2018?

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* 5. What is your current teacher certification/endorsement and certification status?

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* 6. About how many students do you expect to teach science to during the 2017-2018 school year?

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* 7. Are there colleagues from your school who are also applying to participate in the Plant Science Institute?

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* 8. About how much time do you spend teaching plant-related standards?

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* 9. How confident are you in your current plant-related instructional practices?

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* 10. How confident are you in your current genetics-related teaching practices?

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* 11. Please rate your comfort with activities you currently use to make plant processes clear to students.

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* 12. Participation in the Plant Science Institute is dependent upon your attendance during two week long summer sessions (June 19-23, 2017 and June 18-22, 2018) as well as two Saturday events during the 2017-2018 school year (October 21, 2017 and February 3, 2018). If selected for participation, can you commit to attendance on ALL these dates?

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* 13. Participation in the Plant Science Institute will require you to have the support of your building principal (in a letter). Have you spoken to your principal about your potential involvement in the Plant Science Institute and your need for a letter of support from him/her?

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* 14. The Plant Science Institute funding agency requires that we collect certain forms of data from participating teachers. This includes classroom observations of you teaching science, content assessments, and attitude/belief data. If selected for the Plant Science Institute will you commit to completing the required pre- and post-data collection?

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* 15. Why should you be selected to participate in the Plant Science Institute?

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* 16. In the event that you are accepted in the Plant Science Institute, please provide an email address and phone number for us to contact you.

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