Your Name:
First Name
Last Name |
|
| School E-mail Address: |
|
School Name
|
|
School Address:
Street
Town
State
ZIP Code |
|
| Principal: |
|
School Telephone #:
Extension (optional) |
|
| School District: |
|
Home Mailing Address:
Street
Town
State
ZIP Code |
|
|
Home Telephone #:
(for emergency contact in the summer) |
|
Home E-Mail Address:
(for emergency contact in the summer) |
|
Current Teaching Assignment:
(include grade level) |
|
Number of years
teaching experience: |
|
|
Participants must enroll for two weeks and will participate in one session each week. |
| Grade Level: |
|
| July 6-10, 2009: |
|
| First Choice |
|
| Second Choice |
|
| Third Choice |
|
| July 13-17, 2009: |
|
| First Choice |
|
| Second Choice |
|
| Third Choice |
|
|
|
|
Application Deadline:
April 30, 2010
|
Tk20