Registration

Eight-day NSF-funded Professional Development course "Particulate Nature of Matter"
AUGUST 11-14 & AUGUST 18-21, 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 do you hope to gain from this course?

How does your participation in this course 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.

Teachers who complete the course successfully will receive a stipend of $600 and either five 5000-level physics credits or 50 clock hours. There is no tuition cost for the course. There is a $40/credit registration cost, however, which is the responsibility of the participants. Alternatively, participants may register for 50 clock hours (for a smaller registration fee).

Will you register for credit?

Yes No Maybe (please explain)

Please use the space below for any additional comments.