2013 Application

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ENSEsational

SCIENCE

2013 Application

Personal Information (Please Print all Information Clearly)


Name __________________________________________________________
Cell Phone Number (___) ___-____
Home Phone Number (___) ___-____
E-mail __________________________________________________________
Address ________________________________________________________
State _________ Zip Code _______
City _________________________
K-8
K-12
Other _________
Grade Certified to Teach:

Professional Information
Current School Name _____________________________________________
School Phone Number ____________________________________________
Address _________________________________________________________
City _________________________
State _________ Zip Code _______
Current Certification:

Elementary Education
Special Education

Specialist Certification

Other

(speech, art, music, etc.)

_________________

Grade you currently teach

Pre-Kindergarten
Kindergarten
1st Grade

2nd Grade
3rd Grade
4th Grade

5th Grade
Other, please explain
______________________

Years Taught at this position ____________

Program Specialization Information


Special Considerations
Answering this question will not affect approval into program, this information is only used for scheduling and catering
purposes

Diabetic

Vegetarian

Other

Shirt Size (Adult Sizes Only)

Extra Small
Small
Medium

Large
X-Large
XX-Large

XXX-Large

Questions
Describe your philosophy of education in regards to teaching science.

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Briefly share your vision of how the SENSE program will benefit your
teaching and your classroom.

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What are your long-term education plans?

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