Earth's Place in Space

California Science Project 2002

Application

Application Deadline: April 15, 2002

There are still a few spots available, call (530) 898-4322 or email bmarcum@csuchico.edu for details:

______ Two Week Complete Program, June 17 - 28, 2002

______ One Week Introductory Program, June 17 - 21, 2002

Name: ___________________________________________________________

Home Address: _____________________________________________________

City : ______________________________ Zip: _____________ Phone: _________________

Email ________________________________ Social Security Number: ___________________

School: _____________________________________________________________

School Address: ______________________________________________________

City : __________________________ Zip: __________ School Phone: __________________

Principal: __________________________________________________________

District: ___________________________________________________________

County: ___________________________________________________________

Current grade level taught: ______________________

Grade teaching thsi year: ___________________ Years teaching this grade: ___________________

Grades taught previously: __________________ Years teaching those grades: _________________

Degree(s) and year received: _______________________________________________________

Major: _____________________________________

For all of the following questions, attach a separate sheet with typed responses.

  1. Teaching assignments: List the science units you've taught for the past 5 years starting with the current year. If at the middle or high school level, list science classes you've taught. What do you expect to be teaching next year?
  2. Current science textbook(s):
  3. Hands-on science kits used:
  4. Professional Activities/Teacher Leadership: Include recent work-shops, conferences, in-services you have attended, include anywhere you have provided science education leadership beyond your own classroom. Also address your willingness to meet with others in collaborative planning forums.
  5. Submit a personal statement describing your approach to science teaching, your interest in this program, and what your goals are for your personal growth and that of your school.
  6. Submit a letter of recommendation from an administrator or fellow teacher.

Applicant an school/district agreement signatures

Please sign below:

I have- read the requirements and understand that I am expected to comply with each of them to receive the full stipend for the program in question.

Applicant Signature __________________________________________ Date ________________

School/District Commitment

_____ A copay is required from the school or district of $600 for each Two Week participant or $300 for each One Week participant.

_____ Provide time for participating teacher(s) to share their science program.

_____ Pay the travel expenses to and from the summer institute and follow-ups

_____ Maintain financial records for purchases from the participant's instructional materials mini-grant money.

Name ___________________________________ Position ____________________________________

Address ______________________________________________________________________________

Phone __________________________________ Date _____________________

Administrator Signature _______________________________________________________

Mail Completed application to:

Center for Mathematics and Science Education

California State University, Chico

Chico, CA 95929-0530

Ph (530) 898-4322 Fax (530) 898-4580