* Required

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* 1. Surname (Last Name, Family Name)
e.g. Smith, Kowalski...

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* 2. First Name
e.g. Jane, Maria, Susanna, John, Michael...

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* 3. Email address
Please make sure you write your email address correctly

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* 4. Country where you teach

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* 5. City where you teach

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* 6. Name of your school

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* 7. Postal address of your school
Please write the full postal address of your school. For example:
European Schoolnet, Rue de Treves 61, 1040, Brussels, Belgium

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* 8. Have you participated to inGenious before?
Select all the appropriate options

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* 9. Subjects you teach

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* 10. Age of students you will teach during the 2013 - 2014 school year
Select all the relevant ages

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* 11. Does your Principle/School director support the involvement of your school to inGenious?

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* 12. Give us one reason why you would like to be part of this project
Specially why are you interested

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* 13. Give us three reasons why should you be selected to be part of this project
Include experience (eg carried out projects, doing research, participated in other projects, very interested in improving science education, experience with projects' quality assurance)

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* 14. Please answer yes / no

  Yes No
I agree with the tasks, deadlines and conditions of being an inGenious pilot teacher
The director of my school has been informed of my interest in being an inGenious teacher
The school management board has agreed to support my work in the inGenious project, if I am selected
Whether I am selected or not, European Schoolnet may contact me for other projects / events

T