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Monday, April 25, 2011 EET Workshop Registration
Life in Extreme Environments
First Name:
Last Name:
Please enter your primary email address. The address you enter will serve as your unique identifier for workshop registration and payment purposes. Please use the same email address to identify yourself whenever you are prompted to supply it.
Email:
Position:
Classroom Teacher
Staff Development Specialist working with grade 6 to 12 teachers
University faculty working with grade 6 to 12 teachers
Other
If Other, please describe:
Select the grade range that best describes the students you teach:
Grades 6 to 8
Grades 9 to 12
Grades 13 or above
Select the subject area that best represents your primary teaching responsibilities:
Math
Technology
Life science
Physical science
Earth science
Chemical science
General science
Click the check boxes to indicate which subjects you are currently teaching. (Please check all that apply.)
Math
Technology
Earth Systems Science
General Science
Environmental Science
Biology
Space Science
Chemistry
Geology
Atmospheric Science
Ecology
Physics
Integrated Science
Oceanography
Geography
Approximate Number of Students Taught:
School District:
School Name:
School Street Address:
City:
Select a 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 Code:
Estimate the approximate percentages of the student population at your school in the following categories:
African American:
Asian:
Caucasian:
Latino/Hispanic:
Other (please describe):
Estimate the percentage of students at your school for whom English is a second language:
Estimate the percentage of students at your school that receive free/discounted lunch meal tickets:
The platform of the computer you will use during the workshop:
Mac
PC
Other
If Other, please describe:
Type of Internet connection you will access during the workshop:
Slow (dial-up)
Fast (DSL; cable)
Do you have access to Internet connected computers in your classroom?
Yes
No
Do you have access to Internet connected computers in a computer lab that you can use with students at your school?
Yes
No
What type of Internet connection do you have available at school?
Slow (dial-up)
Fast (DSL; cable)
How did you hear about this opportunity?
Would you like to be notified of other EET opportunities such as future teleconference-online workshops?
Yes. Please keep me informed of other EET opportunities.
No thank you. Please do not inform me of other EET opportunities.
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