2009 Summer Course Application

If you would like to apply for next year’s course, please fill out and submit the form shown below. More information about these courses can be found on the web at http://www.rpc.msoe.edu/cbm/courses/.

Questions? Contact Shannon Colton at colton@msoe.edu or 414-277-2824.

Personal Information
Name
Home Address
City, State	,
Zip Code

School Name
School Address
City, State	,
Zip Code
Type of School: Elementary School Middle/Junior High School High School Community College (2 year) School College/University

Phone number	- -
Is this number your Home phone, or your School phone?
Email

Background Information
Educational Background
Courses Taught
Years in Teaching

Short Essay
In 300 words or less, please answer the following question:
How will this course enhance your teaching?


Course Information
Select the course(s) that you would like to attend this summer: Modeling the Molecular World, Part 1: Tactile Teaching With Physical Models(July 6-11, 2009) This course is full for 2009. No further applications will be accepted. Modeling the Molecular World, Part 2: Designing Instructional Materials for the Classroom(July 13-17, 2009) I am requesting lodging in the MSOE Residence Life Hall I do not need a room in the MSOE Residence Life Hall
Do you need a travel stipend? Yes No If you did not receive a travel stipend, would this impact your ability to attend the course? Yes No

Other Information
How did you hear about this course?
Would you be interested in participating in workshops at State and National Science Ecucation meetings?
Yes No
Which meetings have you attended in the past 5 years or plan to attend in the future?
NSTA NABT State (please specify): Other (please specify):	Year Location Year Location Year Location Year Location