Application: June, 2014 LCCC SIM Training Workshop
Today’s Date:
Please TAB from area to area and then fill in the information.
Teacher Name:
Teacher’s Emergency Phone: (
Teacher email:
)
(in case of cancellation, i.e.: illness)
School Name:
School Address:
Subject(s) Taught (check all that apply):
Biology
Chemistry
Environmental Science
Type(s) of computer used in school (check all that apply):
PC
Mac
iPad
Chromebook
Physics
Android Tablet
Date of workshop for which you are applying:
Wednesday, June 18, 2014
Monday June 30, 2014 this workshop is FULL
If the workshop for which you are applying is full, do you want to be considered for the alternate date?
Yes
No
Click on the link to send this form to Mark Case email: mcase1@lccc.edu
You will receive an email within 72 hours confirming the status of your application. A waiting list will be
created once the class size limit is reached. If your plans change and you will no longer be able to attend a
session to which you are registered, please contact Mark ASAP so that he may extend the invitation to another
teacher on the waiting list.