Registration

SUMMER INSTITUTE IN PHYSICS TEACHING
JULY 28-AUGUST 8, 2008
AT SEATTLE PACIFIC UNIVERSITY

PERSONAL INFORMATION:
First Name:
Last Name:
Home Address:
(Home) City:
(Home) State:
(Home) ZIP:
Home/Cell Phone:
Your Email Address at Home:
School Name:
School Address:
(School) City:
(School) State:
(School) ZIP:
School/Office Phone:
Your Email Address at School:

TEACHING EXPERIENCE:
Number of Years Teaching: (including 2007-08)	Year(s)
Current Position: (e.g. classroom teacher, science specialist)
Current teaching assignment, including grade level: (e.g., Physical Science (9) and Biology (10)):
Number of years teaching this level: (or these levels)	Year(s)
Other grade levels or subjects that you have taught:
Certification Status:
	Follow these links for details about certification: http://www.k12.wa.us/certification/teacher/limited2.aspx http://www.k12.wa.us/certification/teacher/teachercertificatetypes.aspx http://www.k12.wa.us/certification/teacher/initial.aspx
Do you hold a National Board for Professional Teaching Standards certificate?	Yes No
Are you currently working toward a National Board for Professional Teaching Standards certificate?	Yes No
Are you interested in pursuing a National Board for Professional Teaching Standards certificate?	Yes No
For more information about National Board certification, please follow this link http://www.nbpts.org/
What endorsements do you currently *hold*?	General Science Biology Earth Science Chemistry Physics Mathematics Middle Level Math/Science Other, please specify
What endorsements are you currently *working on*?	General Science Biology Earth Science Chemistry Physics Mathematics Middle Level Math/Science Other, please specify

QUESTIONNAIRE:

What are some outcomes you hope to gain from this summer institute?

How does your participation in this institute align with your professional goals?

With what textbooks and/or curricula have you had experience in the classroom?

Please list any workshops, conferences, or professional development training in science education that you have attended in the past.

The academic-year follow-up sessions are a key component of this program. These sessions may be scheduled after school (bi-weekly from 4-6 PM), Saturdays (bi-monthly, full day), or on school days with sub release. Total number of session hours offered will be about 60 for the academic year 2008-09. Teachers will be strongly encouraged to participate in at least 80% of the hours offered in these sessions. Can you commit to this?
Yes No Maybe (please explain)

Please express your preference, if any, for different schedules of follow-up sessions (after school, Saturdays, sub release, etc.)