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* 1. First Name

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* 2. Last Name

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* 3. School District

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* 4. Please enter your contact information below:

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* 5. Grades you teach:

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* 6. Subjects you teach:

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* 7. Do you plan to stay in the OSSM Residence Hall?

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* 8. When do you want to check in?

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* 9. Do you want to share a room with another participant?

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* 10. If so, with whom do you wish to share a Residence Hall room?

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* 11. All meals are provided for dorm-resident participants. Lunch is provided for all participants. Sessions will be done by 3 p.m. most days. For non-dorm residents who wish to join for meals, please reserve the meals you plan to attend. Breakfast is served from 7:45 to 8:15 a.m. Supper is from 5 to 6 p.m.

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* 13. Participants must submit a completed W-9 to receive a stipend. Please indicate you understand this requirement. 

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