Project ASTRO™ Teacher Application
Click here for a pdf version of this application.
Fax (415) 337-5205
or send to Project ASTRO™ Applications, ASP 390 Ashton Ave., San Francisco,
CA 94112
The 2006 Project ASTRO™ training workshop will take place August 4-5, 2006 (Friday and Saturday). Participating teachers and astronomers are required to attend.
Return application by May 5, 2006.
Personal Information
Name __________________________________________________
Address _________________________________________
________________________________________________________
City _____________________________________________________
State _________________________________ Zip ____________
Home Phone _____________________________________
E-mail _____________________________________________
School/Organization Information
Name ___________________________________
Address__________________________________________
City______________________________________________
State________ Zip ____________
Phone (_____) _____________________________________
E-mail _________________________________________________
Ethnicity (optional) _____________________________________________
Best way to contact
you __ home e-mail __ work e-mail __ home phone __ work phone __ other
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SCHOOL DEMOGRAPHICS (you must complete this section to be eligible)
School type: ___ public ___ private ___ after-school ___ rural ___ suburban ___ urban
Estimated percentage of students who will be in your class who are:
___ receiving free lunch ___ minority members ___ females
Describe the type and amount of science resources available at your school:
________________________________________________________________________
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Teacher Background - Help us make a good match!
Please briefly describe your educational background, including any science-related studies.
_____________________________________________________________________________
_____________________________________________________________________________
Relevant teaching experiences: Please include professional activities, curriculum development, in-service activities, and collaborative projects.
_____________________________________________________________________________
_____________________________________________________________________________
Grade and subjects you will be teaching next year ______________________________
_____________________________________________________________________________
Years of teaching experience _____________________
What language(s) do you speak? _________________________________________________
Astronomy-related Experience
Have you taught astronomy before? ___ yes ___ no
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)?
_____________________________________________________________________________
How would you rate your astronomy knowledge?
Limited.....1.....2.....3.....4.....5.....6.....Extensive
Working with Project ASTRO™
Why are you interested in working with Project ASTRO™?
_____________________________________________________________________________
_____________________________________________________________________________
How will you include astronomy in your curriculum in 2006-2007?
___ as a unit ___ integrated during the year ___ both ___ other __________________________________
Do you have flexibility to teach astronomy at any time during the year? ___ yes ___ no
If no, please explain: _________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Have you had experience with classroom volunteers? ___ yes ___ no 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 signing this form, I certify that the above statements are true, and that I am able and willing to accommodate such visits during the 2006-2007 academic year.
Signature:____________________________________________________________
Date:__________________________________________
If you have any questions, call (415) 337-1100 x101, or e-mail bayareaastro {at} astrosociety.org.
Administrator support leads to more successful partnerships. Please have the appropriate administrator in your school or district, or Executive Director, certify support for your participation in Project ASTRO™ by completing and signing below. Unsigned applications will not be accepted.
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ADMINISTRATOR SUPPORT (Required)
___ I will support
the participation of (applicant) __________________________________________
in Project ASTRO™, and understand that a local astronomer will be visiting
our school/organization.
___ Our school/organization will contribute $ _____ ($45 recommended) to cover registration and materials for the 2-day workshop. *Note: No one will be excluded because of lack of funds, but contributions to help our project continue are appreciated.
If your school/organization
would like to contribute funds to the program, please make the check payable
to the Astronomical Society of the Pacific, and either submit it with your application,
or bring it to the August workshop. Thank you.
Signature _____________________________
Date______________ Phone ( ) ______________
Name (print) ________________________________
Title _________________________________
Address _______________________________ City _____________________ Zip _____________
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