Hamline University

MnSTEP 2007 Teacher Application

Note: All fields are required unless noted.

I am applying to attend the following MnSTEP summer science institute: (choose one)

First Name:

Last Name:

E-mail Address:

Home Address:
Street:

City:

State:

Zip:

Home Phone:

Gender
Female     Male

Undergraduate degree major, college/university name, and year:

Highest degree earned? Year and Major?

Subjects Taught:

Grades Taught:

For the 2007-08 school year, my teaching assignment(s) will be:

School Name:

School Address:
School Street:

School City:

School State:

School Zip:

County:

District:

School Phone Number:

Fax Number:

School Type:Elem.MSJrHSHS
School Location:urban
suburbanrural
Is your district designated as a “high need school district”, i.e., 20% or more students are from families with incomes below the poverty line?yesno
Is your school on “the list” for not having met AYP goals, or designated as a low performing school?yesno
Number of years of science teaching experience:
Number of years teaching the topic for this summer institute:
In what year did you last take a college-level science course?
Would you need assistance in finding lodging for the five days of the workshop?(lodging is not included)yesno
Please respond to the following three prompts. Limit your responses to 250 words for each prompt.

I feel that quality science education for my students in my classroom needs to be . . .


I want to participate in this summer science experience because . . .

(Optional) In addition, to help you further evaluate my application I would like you to know . . .