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Taking the Pulse of Our Changing Planet
— 2005 Workshop Application Form —

Applications close on April 29. Notification of applicants will be on May 9.

Personal Information
   First Name       Last Name
Home Address
 City  
State
Zip    
Home Phone
(with area code)
 Email Address
 
School Information
School Name
  
School Address
 City  
State
Zip    
School Phone
(with area code)
 School District
 
Teaching Information

Which grade/grades will you teach in 2005-2006?
(check all that apply)

6
7
8
9


 Other (please specify)
Which subject/subjects will you teach in 2005-2006?

Describe your teaching situation and your students (contained classroom, multiple classes, science specialist for school/district, special ed teacher, special needs students, etc.).

What is your training/schooling in the sciences? (check all that apply)
None
Inservice/professional development workshops
Teaching credential with science emphasis
BA/BS in a science field
MA/MS in a science field
Ph.D. in a science field 		Other (please specify)

What is your training/schooling in computer and Internet use? (check all that apply)
None
Self-taught
Inservice/professional development workshops
Teaching credential with computer/technology emphasis
BA/BS in a computer/technology-related field
MA/MS in a computer/technology-related field
Ph.D. in a computer/technology-related field 		Other (please specify)

How many years have you been teaching? (enter a number)

Are you planning on retiring from teaching in the next 5 years? (choose one)
yes
no
not sure

What is your school setting? (choose one)
rural
suburban
urban

What's the ethnic mix of students at your school? (use all the ethnic/racial choices that apply and enter a percentage number for each.)
% Asian
% Black/African-American
% Hispanic/Latino(a)
% Native American/Pacific Islander
% White/Caucasian
% Mixed/Multi-ethnic
% Other
% Don't know
 
Computer / Internet Information

What’s the availability of computers with Internet access at your school?
(Check locations of computers with Internet access and enter the number of computers in each location.)
Computer(s) in your classroom
Computer(s) in a computer lab
Computer(s) in the library/media center
Other (please specify)

How regularly do you have your students use computers at school as part of their lessons? (choose one)
Never
Rarely
Sometimes
Often (monthly)
Regularly (weekly)

How regularly do you have your students use the Internet/websites as part of their lessons? (choose one)
Never
Rarely
Sometimes
Often (monthly)
Regularly (weekly)
 
Real-time Data / Ocean Issues

Have you ever used real-time data in your science lessons with your students? (choose one)

Yes
No
Not sure


If yes, what kind of real-time data? What was the source?


What ocean issue have you read or heard about recently that most concerns you? Why?
 
Short Essay

Explain to us in 100 to 200 words why you're applying for this workshop and what you hope to gain from this experience.

 
Submit the Form

In addition to completing and submitting this form, we ask that you send a letter of support from your school administrator to: (please copy down this address)
Dr. Laura Murray
Horn Point Environmental Laboratory
University of Maryland
P.O. Box 775
Cambridge, MD 21613
Email: murray@hpl.umces.edu