XAVIER UNIVERSITY OF LOUISIANA Science, Engineering, and Mathematics Educational Programs (SEMEP)

advertisement

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

Spring 2005

Summer 2006

MATHEMATICS

CHEMISTRY

Spring 2005

Fall 2006

Summer 2006

Spring 2007

BIOLOGY

Fall 2006

Spring 2007

COMPUTER SCIENCE

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;______________________

Download