Western Regional Noyce Initiative - Functions & Models (Flagstaff, AZ)

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* 1. Contact Information

Name (First & Last) *

Current Teaching Position (school name)

Mailing Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 2. What campus (university/college) are you attending or did you attend while receiving support under the Noyce program?

campus (university/college)

First & Last Name of Principal Investigator (Director or Leader)

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* 3. Noyce grant number under which you were supported at your institution (NSF Noyce project numbers can be found at: http://nsfnoyce.org/project-locator/)

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* 4. Do you have any dietary restrictions?

yes

If your answer was yes, please indicate dietary restrictions.

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* 5. Do you need special lodging accommodations for an existing disability?

yes

If your answer was yes, please explain special accommodations needed.

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* 6. Please check the box below that accurately describes your current status (as of spring 2015)

undergraduate student (have not student taught as of summer 2015)

credential/graduate student (have not student taught as of summer 2015)

recent graduate (have completed student teaching but have not started first teaching position)

1st year teacher

2nd year teacher

3rd year teacher

4th year teacher

5th year teacher

6th+ year teacher

Other (please specify)

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* 7. Please indicate your subject area(s) by checking the appropriate box(es) below.

Mathematics

Biology

Chemistry

Earth Science

Physics

Life Science

Other (please specify)

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* 8. If you are currently teaching, what grade level(s) do you currently teach?

6th grade

7th grade

8th grade

9th grade

10th grade

11th grade

12th grade

Other (please specify)

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* 9. If you are currently teaching mathematics, what courses (content areas) are you currently teaching?

General grade-level mathematics (e.g. 7th grade mathematics)

Pre-Algebra (or equivalent)

Integrated Algebra (or equivalent)

Algebra I

Geometry

Algebra II

Pre-Calculus

Calculus

Statistics

Financial Mathematics

4th year math course

Other (please specify)

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* 10. The Functions & Models WRNI workshop in Flagstaff from June 15 - June 19, 2015...

Are you able to commit to attending all 5 days of the workshop?

Are there any concerns you have with attending or traveling to/from Flagstaff, AZ?

Would you be interested in group excursions to Sedona, the Grand Canyon, neither or both?