Summer 2004 Workshop Application Form

Use this form to apply to any of the three summer Science On The Move workshops.

Name:
School:
Grade(s) you teach:
Classes you teach:
Home address:
City:
Zip:
Home Phone:
Home Email:
School Email:

Is anyone else from your school applying for a 2004 workshop?   ____________

If you answer yes, who should be considered the main contact for your school?

Workshop you are interested in:

____ New (to SOTM) teachers session: June 21 - 25 SDSU

____ Tentative new teachers overflow session: July 26 - 30 BHSU

____ * Veteran MSL teachers (who attended last year) June 28 - July 2 SDSU

Are you interested in graduate credit?   _______ Will you need housing? ______

* Veterans: For which topics / grade levels would you like to develop activities?

Print and return this form to Cathy Bergey, CAMSE Unit 9005, BHSU, Spearfish, SD 57799-9005.

Email: CathyBergey@bhsu.edu                       Phone: 605-642-6873