The Engineering Process
ENG5100
Participant Application
You must complete a participation form and apply for admission to Michigan Tech.
Michigan science teachers will be given first preference.
$300 (includes room and board) for participants who have a valid teaching certificate from
the State of Michigan. Non-Michigan teachers will be charged a reduced tuition/administrative
fee of $950 (does not include room and board).
Please type or print in ink. Duplicate as needed.
Name__________________________________________________________________________________________
First
Middle
Last
Home
address_________________________________________________________________________________________
Street
City
State
ZIP
Date of birth__________________________ MTU M # (if you are a current or former student at MTU)_____________
Home phone (
Fax (
)_________________________________ Work phone (
)____________________________
)___________________________________ Work email_______________________________________
How often do you check your email?________________ Home email______________________________________
School name___________________________________________________________________________________
School address_________________________________________________________________________________
Street
City
State
ZIP
Current subject areas taught_______________________________________________________________________
Grades taught___________________________________________________________________________________
School District__________________________________________________________________________________
Degree earned/areas of certification__________________________________________________________________
Have you taken courses previously at Michigan Technological University? Yes_____ No_____
I plan to take this course for:
□
Non-degree seeking credit (i.e. for permanent teacher certification renewal)
□
Currently enrolled in a graduate program at MTU
□
Currently enrolled in a graduate program at another university
I agree to all of the following to participate in the Engineering Process Course ENG5100.
1)
2)
3)
4)
5)
6)
7)
Read and respond to all preparatory materials and communications prior to the course.
Consent to the release of my name, address, and email address to other participants in the course.
Fully participate in each day of the course.
Meet the requirements of the syllabus for the course.
Understand that my final project may be published in some form.
Consent to the release of my photograph for publications.
My written work submitted in the courses may be used for project evaluation.
Signature_________________________________________________________________Date__________________
Return your completed application by May 20th, 2016 along with the reduced tuition payment and
administrative fee to:
Teacher Professional Development Coordinator
Cognitive and Learning Sciences
Michigan Technological University
1400 Townsend Drive
Houghton, MI 49931-1295
Telephone: 906-487-2460
E-mail: teacherpd@mtu.edu
Applicants who are not selected for participation will be refunded as soon as selection
decisions have been made.
http://www.mtu.edu/cls/education/development/institutes/
*Costs have been reduced through the generous support of the Department of Cognitive and Learning
Sciences to lower official MTU tuition for teachers with proof of current teacher certification (2015/2016
Official Applied Science Education Graduate Resident and Non-Resident is $561.00 per credit).