Exit this survey 2011 CS4HS - Workshop Application 1. Thanks for your interest in attending the Computer Science for High School (CS4HS) Teacher Training Workshop, June 17 - 19, 2011. Please fill out this application in its entirety for full consideration. All Applications must be received no later than May 13, 2011. Question Title * 1. Please fill out the following general information: Name: School Name: Address: Address 2: City/Town: 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: Phone Numbers (work and evening): Question Title * 2. Courses taught: Please list the courses you regularly teach (indicate whether they are required or an elective and which grade level): Question Title * 3. Experience: Please share your experience with technology. You do NOT need a programming or game design background, but if you do have some experience using computers, playing or making games or programming, please share: Question Title * 4. Implementation: How might your participation in this workshop benefit you, your students, and potentially other faculty colleagues? Include any information about the students that you serve that would help is understand the potential impact of your participation. Please share any ideas you have: Question Title * 5. Why are you interested in participating in this computing teacher training workshop? What will you gain personally? Question Title * 6. Do you have access to a laptop that you would be able to bring with you to the workshop? Yes No Question Title * 7. Non Local Applicants (People who would not be able to drive to Boulder, Colorado daily to attend the workshop): Partial or full travel MAY be covered. To request support for travel (airfare, mileage and gas to get to the Boulder) and lodging (Thursday, Friday and Saturday nights) estimate all of your expenses. Please indicate how you would travel and total the amount below: Question Title * 8. Will you be driving to the campus daily to attend the workshop and will you need a parking permit for both days? Yes No Question Title * 9. Do you have any dietary needs that we should be aware of? Yes No Question Title * 10. If yes, please explain: Question Title * 11. Do you have an additional needs that we should be aware of? Question Title * 12. Please use this space to share any additional information that might be pertinent to your application to the program (optional): Thank you for applying for the CS4HS Teacher Training Workshop, June 17 - 19! We will notify applicants of acceptance by May 20. Hope to see you at the University of Colorado at Boulder. Done