Register for 4-day Summer Teacher Institutes at Belle Isle Aquarium for 2019 and 2020
Please complete this registration form for the 4-day Summer Institute for 5th grade DPSCD teachers, entitled "Promoting Student Interest in Science and Science Careers through a Place-based Environmental Educational Program at a Public Aquarium." Participation in the Institute is required in order to bring your 5th grade class on a field trip to the Belle Isle Aquarium, to earn stipends for participating in the project, and to apply for classroom grants that the National Science Foundation -sponsored project offers to 5th grade teachers and their students in DPSCD.

This form has been approved by the Wayne State University Institutional Review Board for use during the period of August 30, 2018 to June 14, 2019.

First Name *
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Last Name *
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Email address: *
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Home Address *
Please type your COMPLETE address: Street or PO Box, City, State, Zipcode
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School Phone Number *
Please include area code
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Cell or Home Phone Number *
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Name of School *
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School Address *
Please include street or PO Box address, city, state, and zip code
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Subjects You Currently Teach *
Required
Are you currently teaching the 5th grade? *
Areas of Teacher Certification
Please indicate any special dietary needs.
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Please indicate your availability to participate in the summer institute in 2019 and 2020. Please indicate the first choice (both dates) unless you have an unalterable conflict in one of the indicated years. (Note that you will only attend one time.) *
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I heard about this Institute from (check ALL boxes that apply)
Have you visited the Belle Isle Aquarium?
Which type of credit do you prefer to earn for attending the 4-day summer teacher institute: *
As a project participant, I agree to: *
Please read and indicate your agreement by checking each box.
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I agree to the statements above. *
Please enter your NAME and DATE in the box below.
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Please list any questions you may have.
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