ASM Materials Camp-Teachers 2020 Application ASM Materials Camp-Teachers 2020 Application Form PLEASE NOTE! Acceptance to the program and all other communications regarding Materials Camp will be sent to you via email only from Jeane.Deatherage@asminternational.org and / or respective local camp location organizers. Please check your spam folder periodically in case your email system delivers camp messages to that folder. Please check both your personal email and work email. Thank you. Please specify which camp location you are applying for: Question Title * 1. First Preference Akron, OH Albuquerque, NM Boston, MA Butte, MT Calgary, Canada Centennial, CO Chicago, IL Cincinnati, OH Cleveland, OH Columbus, OH Dayton, OH Detroit, MI Evanston, IL (Materials Genome) Fort Wayne, IN Hamilton, Canada Hammond, IN Houghton, MI Houston, TX Kansas City, MO Lehigh Valley, PA Milwaukee, WI Naperville, IL New Orleans, LA Norfolk, VA Philadelphia, PA Pittsburgh, PA Quebec City, Canada Salt Lake City, UT Sammamish, WA San Antonio, TX Starkville, MS Tuscaloosa, AL Question Title * 2. Second Preference: Akron, OH Albuquerque, NM Boston, MA Butte, MT Calgary, Canada Centennial, CO Chicago, IL Cincinnati, OH Cleveland, OH Columbus, OH Dayton, OH Detroit, MI Evanston, IL (Materials Genome) Fort Wayne, IN Hamilton, Canada Hammond, IN Houghton, MI Houston, TX Kansas City, MO Lehigh Valley, PA Milwaukee, WI Naperville, IL (K-8) New Orleans, LA Norfolk, VA Philadelphia, PA Pittsburgh, PA Quebec City, Canada Salt Lake City, UT Sammamish, WA San Antonio, TX Starkville, MS Tuscaloosa, AL Question Title * 3. Contact Information (1) First Name Last Name Home Address 1 Home Address 2 City State -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP Country Email Address (this is the primary email we will use to communicate w/ you) Phone Number: Question Title * 4. Contact Information (2) School District County of School District Name of School School Address City State -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP Country Email Address Question Title * 5. Provide type of school Public Private Charter Other (please specify) Question Title * 6. Grade Level/s Currently Teaching Question Title * 7. Years Experience: Question Title * 8. Subjects Taught in Last 2 Years: Question Title * 9. If you have any formal training in materials science or engineering, please briefly describe: Question Title * 10. If you have any industrial experience, please briefly describe: Question Title * 11. What other teacher training programs have you attended in the past five years? Please list the name, location, and length of the program: Question Title * 12. Please list your academic degree/s, including major and minor (if applicable): Question Title * 13. Please write a 100-word essay explaining why you would like to attend this camp and what your expectations are: Question Title * 14. How did you learn about this program? (NSTA journal, friend, etc. - please specify): Question Title * 15. Please provide your citizenship. (This is needed for some industrial tours.) Question Title * 16. Please provide any dietary restrictions, if any: Question Title * 17. Please provide gender. (Note: This info is needed for locations marked "residential" only. Housing is shared room or double occupancy). Male Female Question Title * 18. Please specify your ethnicity: (Some of our financial supporters ask for this information. Thank you.) White Hispanic or Latino Black or African American Native American or American Indian Asian / Pacific Islander Other (please specify) Question Title * 19. Please provide name of principal. Principal's Name: Email Address Phone Number Done