Rivers Institute Application All fields are required unless noted. Personal Information First Name Last Name Work Email Address Summer Email Address Phone Number Date of Birth Gender (Select) Female Male Home Address Street City Zip Code Rivers Institute Please indicate the Rivers Institute you wish to attend. (Select) St. Croix River (June 27-29, 2016) Mississippi River (July 25-27, 2016) If we are unable to admit you to the Institute of your choice, are you interested and able in attending the other? (Select) Yes No Have you participated in a Rivers Institute through Hamline before? (Select) Yes No If yes, when and which one? School Information School Name School District Address City Zip Code State (Select) Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas (except Canada) Armed Forces Europe, Canada, Africa, Middle East Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming County Phone Number Grades Taught Subjects Taught If you are not a classroom teacher, pleas explain your current employment situation as it related to education. Personal Statement Due to space limitations, we are unable to accept all applications. To help us understand why you would like to be a Rivers Institute participant, please write a personal statement (400 words or less) addressing the following questions: What is your personal interest in water, rivers or watersheds? What do you hope to learn by participating in the Rivers Institute Describe the specific kinds of science concepts that interested you most, including process standards, related curricular units, and/or hands on investigations. How do you think this program might help your students learn literacy skills, science or both?