Life Sciences Outreach Spring Program 2017 Application
Life Sciences Outreach will offer laboratory workshops of approximately 3 hours to high school classes. This year, due to changes in our program funding, we will only be offering class-level targeted versions of our PCR and Gel Electrophoresis laboratory. We hope to resume offering our other laboratories in the spring of 2018.

The level of difficulty of the laboratory will be tailored to the individual
 class. Teachers will be required to communicate with Life Sciences Outreach staff ahead of time to determine what is appropriate for their students.

Instructions: Application deadline is Friday, January 6th, 2017.
Accepted applicants will be notified by email.

First Name
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Last Name
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Cell Phone
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Email Address
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School Name
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School Address
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School City
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School State
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School Zip Code
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School Phone Number
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Type of School
Teaching Responsibilities
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Grade level
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Course title and level of attending class
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Please briefly describe this class's familiarity with genetics and PCR.
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Number of students who will attend
Limited to 24 students
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Which week is your FIRST choice for attending?
Is there a preferred day of the week?
Please list any previous Life Sciences Outreach programs you have attended and their dates.
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Please list any accommodations needed for your class.
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