Application

Earthlabs Climate Detectives Workshop

Institute for Geophysics, Jackson School for Geosciences

University of Texas at Austin

Tuesday July 7, 4:30pm – Friday July 10, 3:00pm, 2015

Personal Information:

First Name:

Last Name:

Street Address:

City:

State:
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Zip:

Home Phone:

Cell Phone:

Home Email:

How did you find out about this opportunity?


Completion of the questions about gender and race is helpful for reporting statistics to our funders, but is voluntary.

Gender:

female
male

Race:

African American
Asian
Caucasian
Latino/Hispanic
Other

If Other, please describe:


Professional Preparation:

Undergraduate Degree Major(s):

Graduate Degree Major(s):


Information about the school where you teach (2014-2015 school year):

School District:

School Name:

School Address:

City:

State:
State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:


School Phone:

Fax:


Your Email at School:



Teaching Information (2014-2015 school year):

Click the check boxes to indicate which subject(s) you are currently teaching:
Earth Science
Environmental Science
Please list other subjects you are currently teaching:


Grade(s) you are currently teaching.


Number of years you have been teaching.



Teaching Information (Anticipated for 2015-2016 school year):

Click the check boxes to indicate which subject(s) you will be teaching:
Earth Science
Environmental Science
Please list other subjects you will be teaching:


Grade(s) you will be teaching:



Other info:
Please describe in the box below how you anticipate incorporating the knowledge and experience you gain at the "Climate Detectives" Summer Workshop into your classroom curriculum.

Name Email