IWP Summer 2017 Registration Form
Please complete this registration form.
Then, submit the $50 registration fee with your credit card via PayPal: http://wp.me/P5MmqV-ai
OR
Mail a $50 check to: Dr. Steve Zemelman, Illinois Writing Project, 9423 Lincolnwood Drive, Evanston, IL 60203
Which program(s) are you interested in attending this summer? *
Required
Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
School *
Your answer
School's Town *
Your answer
Grade or Position *
Your answer
Email *
Your answer
Daytime Phone *
Your answer
Evening Phone *
Your answer
IF YOU ARE REGISTERING FOR THE LEADERSHIP INSTITUTE: Please respond to the following.
1. Give a brief history of your teaching experience.
Your answer
2. Why are you interested in joining the IWP Summer Leadership Institute?
Your answer
3. In what leadership roles have you been engaged? (education settings or elsewhere)
Your answer
4. What leadership roles do you hope to personally develop in the future (in your classroom, building, district, or beyond)?
Your answer
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