2016 Designing a Sustainable Future Teacher Institute ~ July 11

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2016 Designing a Sustainable Future Teacher Institute ~ July 11 - 15

First Name *

Last Name *

Email address: *

Home Address *

Please type street or PO Box address, City, State, and zipcode

Work Phone Number *

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Cell or Home Phone Number *

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Name of School or Place of Employment *

School/employer's Address *

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Subjects Taught *

Grades Taught *

Degree(s) Earned/Areas of Teacher Certification

Please indicate any special dietary needs, with description.

I heard about this Institute from (check ALL boxes that apply)

Friend or colleague

Math/Science Center

Teacher or school administrator

Michigan Science Teachers Association

Website

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Other:

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Have you taken courses previously at Michigan Technological University (MTU)?

Yes, I have taken courses previously at MTU

No, I have not taken courses previously at MTU

I plan to take this Institute for

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Non-degree seeking credit (i.e. for permanent teacher certification renewal)

Currently enrolled in a graduate program at MTU

Currently enrolled in a graduate program at another university

I do not want to enroll for MTU credit, but will complete all assignments

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As an institute participant, I agree to *

Please read and indicate your agreement by checking each box.

Read and respond to all preparatory materials and communications prior to the Institute.

Fully participate in each day of the Institute.

Develop lesson plans as required to implement during the 2016-2017 school year.

Give my permission for any original work that I may produce as a result of my participation in the Institute, including lessons and all materials submitted for credit, to be published in any format by Michigan Tech University (MTU), Western UP Center for Science, Math & Environmental Education, School of Forest Resources & Environmental Science at Michigan Technological University, and the MTU Center for Science & Environmental Outreach.

Allow photos of myself taken during the Institute to be used in publications, electronic media, presentations, and demonstrations, and to use my name if pictures are published.

The release of my name, mailing address, and email address to other participants in this Institute.

Required

I agree to the statements above. *

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