Dinner with a Scientist 2018 - Teacher Registration Form
NOTE THAT REGISTRATION FOR THE SECONDARY EVENT IS NOW CLOSED. IF YOU WOULD STILL LIKE TO ATTEND, PLEASE EMAIL CALEB CHEUNG (CALEB.CHEUNG@OUSD.ORG) FIRST TO SEE IF THERE IS STILL ROOM.

ELEMENTARY TEACHERS CAN STILL REGISTER USING THIS FORM UNTIL APRIL 27.

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Dear Science Teacher,

Thank you for your interest in attending our Dinner with a Scientist events!

Note that this registration form is for either of two events and limited to teachers in the Oakland Unified School District.

The secondary event on May 8 is open to all middle and high school science teachers.

The elementary event on May 7 is limited to teachers who are nominated by their principals. Please do not completed this form unless you have been invited to do so.

Each teacher can select up to 2 students to attend. Should the event exceed capacity, priority will be given to teachers who register first.

Please make sure all names are spelled properly with capitalization as they will be used to create name tags and other event materials.

The registration deadline is April 27. Additional information is on our website at https://sites.google.com/ousd.k12.ca.us/science/events/dinner-with-a-scientist

Caleb Cheung
Director of Education
Chabot Space and Science Center
caleb.cheung@ousd.org

Email address *
Please select your school site. *
Teacher Full Name (First and Last) *
Your answer
Which event are you attending? *
Email Address (Note that all event communication will be through email. Please enter one that will be checked daily.) *
Your answer
School Phone *
Your answer
Cell Phone (in case of emergencies) *
Your answer
Home Phone (in case of emergencies)
Your answer
Grades Taught *
Required
Science Courses Taught (secondary only)
Your answer
Number of students that will be joining you (two max). Names of actual students will be collected a week before the event. *
Depending on the number of guests, there may be space for some teachers to bring a third student. Are you interested? If so, we will contact you the week before the event. If need exceed capacity, we will choose teachers randomly. *
The dinner will include vegetarian options. Let us know if you have any other dietary needs.
Your answer
How will your students most likely arrive at the event (check all that apply)? *
Required
Please note that you are responsible for any permission forms and transportation. A standard form for the event is on our website. We suggest teachers drive with their students and take them home after the event if possible. Alternatively, a parent or guardian can drop off the students and pick them up. Due to limited space, we will not be able to accommodate any parents, guardians, or other individuals at the event.
Any comments?
Your answer
Thank you for your information. Please click submit when finished.
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