"Sustain Your Learning Environment"
Arizona Center for STEM Teachers 2015 Summer Institute Application

(Funding provided by the Agnese Nelms Haury Program in Environment and Social Justice)

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* 1. How did you hear about the 2015 ACST Summer Institute?

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* 2. What is your last name?

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* 3. What is your first name?

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* 4. Your gender is:

Male

Female

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* 5. What is the BEST email address to contact you at? This should be an address you check BOTH during the school year and the summer time! (Check spelling carefully!)

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* 6. What is the BEST phone number to contact you at?

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* 7. Home address: Street and number

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* 8. Home address, line 2 (if necessary)

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* 9. Home address, City

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* 10. Home address, zip code

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* 11. School Name

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* 12. School address, street and number

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* 13. School address, line 2 (if necessary)

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* 14. School address, city

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* 15. School address, zip code

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* 16. School type:

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* 17. Does your school have a focus? E.g. Math and Science, Reading First, Montessori, etc.

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* 18. What is your School District?

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* 19. School District type:

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* 20. Grade level/teaching assignment for 2015-2016 school year:

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* 21. How many years of teaching experience do you have?

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* 22. Do you understand that you will be expected to teach your students skills and concepts learned at the 2015 ACST Summer Institute?

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* 23. Do you understand that the Biosphere 2 campus has extreme conditions: hiking, steep hills, activities outdoors in 100+ degree summer temperatures, and that Biosphere 2 is NOT handicapped accessible? You will be asked to traverse this environment often.

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* 24. Do you know someone who has attended an ACST Summer Institute in the past? If yes, please enter their name (first and last) in the box. If no, please enter 'no'.

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* 25. How comfortable are you in teaching Reading? (4-part rating scale, 4 = most comfortable, 1 = least comfortable)

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* 26. How comfortable are you in teaching Science? (4-part rating scale, 4 = most comfortable, 1 = least comfortable)

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* 27. How comfortable are you in teaching Mathematics? (4-part rating scale, 4 = most comfortable, 1 = least comfortable)

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* 28. How comfortable are you in teaching Social Studies? (4-part rating scale, 4 = most comfortable, 1 = least comfortable)

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* 29. How comfortable are you in teaching Technology? (4-part rating scale, 4 = most comfortable, 1 = least comfortable)

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* 30. In teaching, what is an area of strength for you? Please elaborate. 50-300 words (approx. 2000 characters)

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* 31. In teaching, what is an area of weakness for you? Elaborate on what you would like to develop. 50-300 words (approx. 2000 characters)

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* 32. What technology, if any, do you incorporate into your classroom? Please elaborate. 50-300 words (approx. 2000 characters)

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* 33. Why do you want to come to this summer institute? 50-300 words (approx. 2000 characters)

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* 34. I understand that if I am selected to attend the 2015 ACST Summer Institute, I must provide a NON-REFUNDABLE $100 deposit to secure my spot. This deposit must be made within a few weeks of notification of acceptance of my spot. If I do not make this deposit I understand that my spot may be revoked and given to another applicant. Details for making the deposit will be sent via email to all selected participants.

I understand that if I am selected to participate in the 2015 ACST Summer Institute, I must make a non-refundable deposit of $100 to secure my spot.

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* 35. By submitting this completed application, you acknowledge that you understand that this professional development experience requires strenuous activity, that the terrain at the Biosphere 2 campus is challenging and has extreme conditions, and that Biosphere 2 itself is not handicapped-accessible. We would rate the campus at a difficulty level of C-D, using the following rating scale:

Level A - Very easy. Mostly flat terrain
Level B - Easy hike. Some hills.
Level C - Moderate for most people. Some steep hills.
Level D - Challenging, steeper terrain.
Level E - Difficult.

We encourage you to keep this in mind when applying.

The voluntary submission of this completed on-line application serves as your electronic signature.

Thank you to the Agnese Nelms Haury Program in Environment and Social Justice for funding the 2015 ACST Summer Institute.