Name:

Address:

City:

State:

Zip:

Home Phone:

E-mail:

Ethnicity (optional):

Best way to contact you:

Name:

Address:

City:

State:

Zip:

Phone:

E-mail:

School type:

Estimated percentage of students who will be in your class who are:

Describe the type and amount of science resources available at your school:

Please briefly describe your educational background, including any science-related studies.

Relevant teaching experiences: Please include professional development activities, curriculum development, in-service activities, and collaborative projects.

Grades and subjects you will be teaching next year.

Years of teaching experience:

What language(s) do you speak?

Have you taught astronomy before?

If so, for how long?

Please list any other astronomy or science activities in which you are involved.

When during the year do you plan to teach astronomy (approximate months)?

Why are you interested in working with Project ASTRO?

How will you include astronomy in your curriculum in 2012-13?

Do you have flexibility to teach astronomy at any time during the year?

If no, please explain:

Have you had experience with classroom volunteers?

If yes, please explain:

How did you hear about Project ASTRO?

I agree to attend the August two-day workshop and understand that if I am unable to attend, I will not be eligible to participate in Project ASTRO. Astronomers and teachers are required to commit to at least 4 classroom visits per academic year. By checking the box above, I certify that the above statements are true, and that I am able and willing to accommodate such visits during the 2012-2013 academic year.