Learning the Namaste Way

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Please complete this form to apply for a 2014 - 2015 Learning the Namaste Way Institute. This year's Institutes will take place on October 22 - 24, 2014 and June 3 - 5, 2015 at Namaste Charter School.
Once your application has been accepted, payment will be due. Please contact Amanda at aaristeo@namastecharterschool.org with questions or for additional information.

Name *

School or District *

Address *

City, State *

Zipcode *

Phone Number *

Email *

Which Institute would you like to attend? *

October 22 - 24, 2014

June 3 - 5, 2015

Select School Type *

Note: If your school is not yet open, please provide projections or estimates for the questions below.

Traditional Public

Private

Charter (currently open)

Charter (opening in the future)

What is your role? (If teacher, specify grade level/s and subject/s taught) *

What is the racial and ethnic breakdown of students at your school? *

Mostly African-American

Mostly Hispanic

Mostly White

Other:

Does your school offer Dual Language/Spanish instruction? *

Yes

Plan to include Dual Language/Spanish instruction

What is the percentage of students qualifying for free or reduced lunch at your school? *

Does your school have "specials" (PE, Music, Art)? If so, please specify. *

Does your school have recess daily? *

Yes

What (if anything) has your school or district done to address the childhood obesity epidemic and/or create a healthier school environment? *

If applicable, what have you (in your current position) done to address the childhood obesity epidemic and/or create a healthier school environment? *

If applicable, what challenges have you, as a classroom teacher, school leader or staff member, faced in implementing a holistic approach to education or in implementing new policies pertaining to health and wellness in the school day? *

Which of the following issues are of most concern to you in your school or district? (Select up to three answers) *

Nutrition Education

School Meals (Breakfast, Lunch)

Healthy Eating Outside of School

Physical Activity

Physical Education

Parent/Family/Community Support

Policy Issues/Schoolwide Practices

Violence Prevention/Safety

Health (i.e., hygiene, sex ed)

Students with Special Needs

Other:

Required

Why are you interested in attending the Learning the Namaste Way Institute? *

If funds are available would you be interested in applying for a scholarship (up to $149) to the Learning the Namaste Way Institute?

The cost of the Learning the Namaste Way Institute is $249.

Yes

Are you a Chicago teacher or school leader?

The cost of the October 22-24, 2014 Learning the Namaste Way Institute is $100 for Chicago teachers and school leaders.

Yes

How did you hear about Learning the Namaste Way? *

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