XAVIER UNIVERSITY OF LOUISIANA
Science, Engineering, and Mathematics Educational Programs (SEMEP)
Department of Physics and Dual Degree Engineering
Application for STEM Saturday Workshop Series for In-service Teachers
Date: ____________________________
Name:: ________________________________________________________________________
Mailing address: _________________________________________________________________
City: ________________________________ State: ________ Zip Code __________________
Daytime phone: ____________________________ Evening phone: _______________________
E-mail address: _________________________________________________________________
Workshops you wish to attend: (Please check all that apply)
PHYSICS
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Spring 2005
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Summer 2006
MATHEMATICS
CHEMISTRY
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Spring 2005
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Summer 2006
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Fall 2006
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Spring 2007
BIOLOGY
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Fall 2006
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Spring 2007
COMPUTER SCIENCE
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Fall 2007
Name of Middle/High School: ______________________________________________________
Courses you currently teach: ______________________________________________________________
Grade(s) taught: ____________________________ # of years as a teacher: _________________
How long have you taught this level or subject? ____________________________
Other grades or courses you have taught:: ___________________________________________________
Signature: ________________________________________ Date;______________________