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 *
Your answer
Last Name *
Your answer
Cell Phone *
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Email Address *
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School Name *
Your answer
School Address *
Your answer
School City *
Your answer
School State *
Your answer
School Zip Code *
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School Phone Number *
Your answer
Type of School *
Teaching Responsibilities *
Your answer
Grade level *
Your answer
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. *
Your answer
Please list any accommodations needed for your class. *
Your answer
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