High School Physics and Biology Teachers Summer Workshop Application

Name: _______________________________________________________________________

High School: __________________________________________________________________

Street Address: ________________________________________________________________

City: ___________________________________    State: _______    Zip: __________________

School Phone: _________________  Fax: _________________Home Phone: ________________

E-mail address: _________________________________________________________________

Number of years in teaching :__________

Courses currently teaching : ________________________________________________________

Other courses you have taught: _____________________________________________________

Total enrollment in your high school: ________ Average science class size: __________

Demographics of your school: (Please enter approximate percentages)

_____ % Caucasian                 ______% African American     ______% Asian American

_____ % Hispanic or Latino     ______% Mixed race               ______% American Indian

_____ % Native Hawaiian or Other Pacific Islander

Approximate percentage of students who qualify for reduced lunch: _______%

Do your students or your school own TI graphing calculators?  □ yes     □ no

Does your school own Calculator Based Laboratories (CBLs)? □ yes   □ no

If so, how many?   __________ 

Does your school use a different, yet similar computer or calculator-based technology?
       □ yes    □ no  If yes, what type?  _______________________

Does your school have Internet access? □ yes   □ no

 Will your school be interested in the possible purchase of an equipment package (most materials from Vernier, Carolina Biological, Pasco, and Sargent Welch) to support the use of the curriculum in your classroom?  Classroom packages average $1250.
        □ yes            □ no

Please ask your department chair or principal to write a brief letter of support for your application and to mail it to the address given below.  Give the name of the person who will write your letter here: ______________________________________

Why do you want to attend this workshop?  Please attach a separate sheet with your response.

  Signature: ___________________________              Date: ____________

Applications are due no later than March 15, 2004.  Notifications will be made by April 1.

Questions? E-mail Stacy Klein at stacy.s.klein@vanderbilt.edu or call 615-322-6085

Return to: Stacy S. Klein, Ph.D, Department of Biomedical Engineering, Vanderbilt University, Station B, Box 351631, Nashville, TN 37235-1631 or fax to 615-343-7919.

[download as MS Word document]