Leap into Science Application - Balance Themed Workshop in Roseburg
Please fill out this form if you are interested in attending our Leap into Science training in Roseburg on December 1st. The training will be held from 9am-1pm at the Boys & Girls Club of Umpqua Valley. This training is focused on providing informal science & literacy activities as well as facilitation strategies for engaging youth and their families.

Participating Programs/Sites Will Receive:
Evidence-based curricula and kit of materials**
Professional development in how to lead Leap into Science workshops for young children and families
Network of informal educators who are committed to science and literacy
Ongoing technical support from our state leaders and national project team

As part of a national pilot, there are several key requirements for everyone who is given a kit, please answer the questions below to the best of your ability to help us ensure requirements can be met. We have access to a limited number of kits, they will be first come first serve the those who apply to meet all of the expectations listed in this application. Requirements are in reference to each kit that is dispersed. If there are multiple people from an organization, the expectation is that each kit will be used for 2 youth workshops and 1 family workshop.

Thank you for your interest in participating in this pilot and supporting the expansion of science and literacy opportunities throughout Oregon! You can find out more at www.oregonask.org/leap-into-science/

Your Name *
Your answer
Organization *
Your answer
Email *
Your answer
What county is your organization in? *
Your answer
Will you be able to bring another person from your organization? If yes, please include their name below *
Can your organization facilitate at least two 45 min. or longer workshops per year for children either 3-5 years old and/or 5-10 years old? *
The 45 minute workshops can also be broken up into shorter activity times if you plan to do multiple days but you will be expected to provide at least 45 minutes per 'workshop'.
Can your organization facilitate one hour long workshop with children, family and community? *
Can you lead an event during National Leap into Science Week (last week of February)that spreads the word about Leap into Science? *
We do not yet have strict guidelines on what this would entail but we would expect all trainees to participate in some way
Can you participate in quarterly calls for trained educators in Oregon? *
Can you complete brief online surveys after each event and at end of program year (Spring 2019)? *
In your current position, have you passed a background check to work with children? *
You do not need to have passed in order to attend or implement, this is simply to help understand the audience we are reaching.
If you answered no or maybe to any of the above, please describe why:
Your answer
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