2018 Workshop Application - May 29-June 1, 2018

Application Deadline: March 20, 2018

Application for K-12 Teachers, Park & Museum Interpreters, and Emergency Management and Health & Safety Educators

This workshop is primarily for participants from Anchorage, Kenai, and Kodiak areas. Educators from other areas should contact EarthScope ANGLE to see if you are eligible to apply.

There are three sections to the application, Basic Information, Background Information and Registration Information. Please make sure to complete all three sections and select the Submit button at the end.

* indicates a required question.

For questions or further information, contact EarthScope ANGLE.

Basic Information*I am primarily a

Classroom Teacher
Interpreter/Guide
Emergency Management or Health/Safety Educator
Other

If other please describe:

*First Name

*Last Name

*Work Email

*Confirm Work Email

Please Note: Your email address is what we use to track your application and participation in the workshop. Be sure to use the same email address in all forms relating to your workshop participation. This email will also be our primary means of communication with you.

Secondary Email (optional)

*Phone

*Workplace Mailing Address

*City

*State

*Zip Code

Background Information*Organization/School

Department

If you are a teacher, what grade level(s) do you teach?

If you are an interpreter or other public educator, what audiences and age ranges do you work with?

*Region or site where you educate learners (knowing this accurately will help us target resources to your area)

What is your highest degree earned?

*Experience in emergency management or health/safety education (in years)

*Experience interpreting (in years)

*Experience teaching (in years)

*Experience teaching/presenting Earth Science (in years)

List other relevant education, work, or volunteer experience

*Please describe the reasons you would like to participate in this workshop

*What are your plans to incorporate EarthScope ANGLE content into your education program(s)?

How might you be able to carry your workshop learning to other educators?

Registration Information*I agree to attend full four days May 29-June 1, 2018

Yes
No

*I agree to attend the Share-a-thon in Anchorage Saturday February 2, 2019

Yes
No

Interested in lodging (if available) for the nights of: (check all that apply)
Monday, May 28
Tuesday, May 29
Wednesday, May 30
Thursday, May 31

Roommate Request (housing if provided will be shared with same-gender participant unless you wish to pay the difference to have a single)

Please describe any other food allergies, preferences, or dietary restrictions that require accommodation at the workshop

Comments or concerns (optional):

Name Email