Project Management Classroom Initiative Application - Phase One

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* 1. First Name:

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* 2. Last Name:

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* 3. Job Title/Area of Specialization:

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* 4. What is your grade level?

K-3

4-6

7-8

9-12

Other (please specify)

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* 5. School email address:

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* 6. Years of teaching experience:

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* 7. Alternate email address:

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* 8. Phone:

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* 9. Home Address:

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* 10. City:

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* 11. State:

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* 12. Zip:

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* 13. Knowledge of Project Management (Scale of 1-5, with 1=No Knowledge and 5=Highly Knowledgeable

No knowledge of Project Management

Understand Project Management but have not used it

Understand Project Management but struggle to use it

Understand Project Management and have used it some

Highly knowledgeable of Project Management

No knowledge of Project Management

Understand Project Management but have not used it

Understand Project Management but struggle to use it

Understand Project Management and have used it some

Highly knowledgeable of Project Management

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* 14. Knowledge of Project-Based Learning (Scale of 1-5, with 1=No Knowledge and 5=Highly Knowledgeable

No knowledge of Project-Based Learning

Understand Project-Based Learning but have not used it

Understand Project-Based Learning but struggle to use it

Understand Project-Based Learning and have used it some

Highly knowledgeable of Project-Based Learning

No knowledge of Project-Based Learning

Understand Project-Based Learning but have not used it

Understand Project-Based Learning but struggle to use it

Understand Project-Based Learning and have used it some

Highly knowledgeable of Project-Based Learning

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* 15. List professional presentations that you have made to adult learners.

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* 16. School Name:

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* 17. School Mailing Address:

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* 18. School Phone:

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* 19. School City:

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* 20. School State:

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* 21. School Zip:

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* 22. School Setting:

Urban

Suburban

Rural

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* 23. School Ethnicity %: (total must equal 100%)

African American

American Indian

Asian

Caucasian

Hispanic

Other

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* 1. First Name:

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* 2. Last Name:

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* 3. Job Title/Area of Specialization:

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* 4. What is your grade level?

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* 5. School email address:

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* 6. Years of teaching experience:

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* 7. Alternate email address:

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* 8. Phone:

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* 9. Home Address:

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* 10. City:

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* 11. State:

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* 12. Zip:

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* 13. Knowledge of Project Management (Scale of 1-5, with 1=No Knowledge and 5=Highly Knowledgeable

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* 14. Knowledge of Project-Based Learning (Scale of 1-5, with 1=No Knowledge and 5=Highly Knowledgeable

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* 15. List professional presentations that you have made to adult learners.

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* 16. School Name:

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* 17. School Mailing Address:

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* 18. School Phone:

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* 19. School City:

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* 20. School State:

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* 21. School Zip:

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* 22. School Setting:

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* 23. School Ethnicity %: (total must equal 100%)

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* 24. % of Free/Reduced Lunches: