Application Form
March 2008-March 2009 Program

Note: Participation in the program is limited to Massachusetts classroom teachers (grades 6-12) who expect to be teaching science, math, or technology during the 2008-2009 school year, and who have reasonable access to computers with an Internet connection.

Personal Information:

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Home Phone:

Home Email:


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:



It is essential that you have ready access to an internet-connected computer, at home or school, for your use during the distance-learning component of the program.

What type of Internet connection do you have on the computer available for your personal use—at home or at school—for the distance-learning component of the program?

Dial-up
DSL
Cable
ISDN
T1 Line

What is the platform of the computer that you will be using for the distance-learning component of the program?

Mac
PC

What operating system does this computer use (i.e. Windows VISTA, Mac OS. 10.4, etc.)?


Rate your degree of experience with distance learning courses.

Experienced
Some
None

Professional Preparation:

Undergraduate Degree Major(s):

Graduate Degree Major(s):


School Information:

School Name:

School Address:

City:

State:

Zip:

School Phone:

Your Email at School:

Fax:



What is the best method for contacting you?

Home Email
School Email

Teaching Background:

Click the check boxes to indicate which subjects you are currently teaching:
Earth Science
Life Science
Technology
Math
Other subjects? Please list:



Click the check boxes to indicate which subjects you have taught in the past.
Physical Science
Earth Science
Life Science
Technology
Math
Other subjects? Please list:


Grade(s) Taught:

For how many years have you been teaching?

What grade(s) are you teaching this year?

Approximately how many students do you teach in a year?



Technology Access:

A central component of this program involves teachers and students using computers in their schools, and as part of classroom instruction. It is essential that both you and your students have adequate access to computers with Internet access.

How many computers do you have in your classroom?

Of those computers, how many are connected to the Internet?

How often can your students access a computer lab or a classroom set of computers?

How many computers can your students access in a computer lab or via a classroom set?

Of those computers, how many are connected to the Internet?

What is the primary platform of the computers that you will use to carry out DataTools activities with your students?

Mac
PC

Present Use of Technology in Your Teaching:

How often do you currently use computer-based activites in your teaching?

Daily
Several times per week
Weekly
Monthly
Ocassionally
Not at all

How often do you use Internet-based resources in your teaching?

Daily
Several times per week
Weekly
Monthly
Occasionally
Not at all

If you have used Internet-based resources in classroom instruction, please describe what you or your student did.


Students at Your School:

Estimate the approximate percentages of the student population at your school in the following categories:

African American:

Asian:

Caucasian:

Latino/Hispanic:

Other:

If you included a percent for Other, please describe the category:

Use the box below for any other information you'd like to include with your application.



By submitting this application, I am indicating that I have read the Agreement and have reviewed the Calendar. Name Email

DataTools is an Information Technology Experiences for Students and Teachers (ITEST) Program, created and administered by TERC Inc. under Expanding the Data Cycle grant from the National Science Foundation.