DPS 2014 Workshop Registration

Small Worlds: Big Discoveries Educator Workshop - Registration

We are excited to have you join us for the Small Worlds: Big Discoveries educator workshop in association with the American Astronomical Society's Division for Planetary Sciences annual conference on Sunday, November 9, 2014!

Please provide the information requested below so that we can stay in contact with you about the workshop and tailor the experience to meet your needs. Please note that questions marked with an asterisk (*) before the question number require an answer.

A maximum of 30 participants can be accommodated on a first-come-first-served basis.

Need more information or have questions? Contact Sarah Horst: Sarah.Horst@jhu.edu.

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* 1. First Name

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* 2. Last Name

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* 3. Title (for example, Ms., Mrs., Mr., Dr., etc.)

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* 4. Please provide your contact information:

School / organization *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Summer / Home Email Address: *

Phone Number:

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* 5. What grade levels do you teach?

5-6

7-8

9-10

11-12

Informal education

Other (please specify)

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* 6. Please characterize the approximate demographics of the students that your school serves.

My school is primarily rural / suburban / urban

Percentage of students on free or reduced lunch

% White

% Black

% Hispanic or Latino

% Asian

% American Indian

Other origin

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* 7. What subjects do you teach?

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* 8. What space science content do you currently explore with your students?

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* 9. What science content do you hope to learn at this workshop?

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* 10. Please share any other learning or professional development goals you have with respect to this workshop.

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* 11. Please share any allergies, dietary restrictions, or physical limitations that may impact your participation, so that we can help to make the experience more accessible and pleasant for you. If none, please write "none."

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* 12. How did you learn about this workshop?

Colleague

Principal / Superintendent

Science Coordinator

E-mail

Social media

Other (please specify)

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* 13. Will you be able to bring a computer to the workshop to access electronic resources?

Yes

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* 14. Please share any additional information you would like the workshop providers to know.

Thank you for registering! Please hit the Done button to submit your registration. If you do not see a new screen that says Thank you, please contact Heather Dalton at dalton@lpi.usra.edu.