2017 Salt Marsh STEAM: Teacher Workshop Application

Communicating Science through the Arts - July 24-28, 2017

Applications are due by May 20, 2017.
Registration is $100 and includes all supplies, lesson plans, lodging, and food.
Open to 3rd-5th grade teachers*, pre-service teachers, and non-formal educators
Requirements: Commitment to five-day workshop, plus pre-webinar and post follow-up. MUST be able tolerate summer temperatures, insects, and physical activity. Upon completion of the workshop, teachers must develop a lesson plan to be shared with all participants.

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* 1. Name

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* 2. Home Address:

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* 3. City:

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* 4. State:

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* 5. Zip Code:

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* 6. Cell Phone:

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* 7. Home Phone:

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* 8. Email: (that you access in the summer)

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* 9. School Name or place of work:

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* 10. School District:

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* 11. Work Address:

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* 12. City:

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* 13. State:

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* 14. Zip Code:

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* 15. Work Phone:

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* 16. Which grade(s) do you teach?

Other (please specify)

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* 17. What subject(s) do you teach?

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* 18. How many years have you been teaching?

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* 19. How did you learn about this course?

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* 20. How proficient are you in the following technologies:

	expert	intermediate	beginner	what is that?
Powerpoint	Powerpoint expert	Powerpoint intermediate	Powerpoint beginner	Powerpoint what is that?
Prezi	Prezi expert	Prezi intermediate	Prezi beginner	Prezi what is that?
ipad	ipad expert	ipad intermediate	ipad beginner	ipad what is that?
iphone	iphone expert	iphone intermediate	iphone beginner	iphone what is that?
other tablet	other tablet expert	other tablet intermediate	other tablet beginner	other tablet what is that?
other smartphone	other smartphone expert	other smartphone intermediate	other smartphone beginner	other smartphone what is that?
webinars	webinars expert	webinars intermediate	webinars beginner	webinars what is that?
google docs/drive	google docs/drive expert	google docs/drive intermediate	google docs/drive beginner	google docs/drive what is that?
google forms	google forms expert	google forms intermediate	google forms beginner	google forms what is that?
SMARTboard	SMARTboard expert	SMARTboard intermediate	SMARTboard beginner	SMARTboard what is that?
Promethian Board	Promethian Board expert	Promethian Board intermediate	Promethian Board beginner	Promethian Board what is that?
other electronic whiteboard	other electronic whiteboard expert	other electronic whiteboard intermediate	other electronic whiteboard beginner	other electronic whiteboard what is that?

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* 21. My students have access to a computer with internet: (choose all that apply)

at home

at school, one computer on whiteboard in front of class

at school, each student (or group of students) has their own computer

at school, each student (or group of students) has tablet

Other (please specify)

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* 22. Please indicate any special needs or medical conditions you may have:

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* 23. Do you prefer vegetarian meals?

Yes

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* 24. Indicate food allergies:

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* 25. Why do you want to participate in this course?

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* 26. If you are selected, how will you use the information learned in your classroom?

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* 27. What other workshops, courses, or trainings have you participated in the last two years?