Application Form page 1
TEACHING SCIENCE AND MATHEMATICS IN MULTILINGUAL CONTEXTS IN LEBANON
A SUMMER INSTITUTE FOR TEACHERS
September 1-3 & 5-6, 2016
Science and Mathematics Education Center
Department of Education, AUB
Application Form
Full Name: __________________________________________________________________________
Do you teach science, mathematics or both?
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Science
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Mathematics
Gender
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Male
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Female
Please provide the following information about the school that you teach at:
Name of the school ______________________________________________________________
Specify the location of the school ___________________________________________________
Specify whether it is a public or private school:
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Public
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Private
The language(s) of instruction that is/are adopted in the school to teach science or mathematics
is/are:
 English
 French
 Arabic
 Other
What grade level(s) do you teach?
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Lower elementary school cycle (Grades 1-3)
Upper elementary school cycle (Grades 4-6)
Middle school cycle (Grades 7-9)
Secondary School cycle (Grades 10-12)
Application Form page 2
What is your teaching position?
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Assistant teacher
Teacher
Coordinator/Department Head
Other (please specify): _________________________________________________________
Specify the number of years of teaching experience you have ___________________________________
What is your highest level of education? Check one of the items below.
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High School
Bachelor of Science (Chemistry, Physics, Biology) (Indicate area of specialization)
Bachelor of Science (Mathematics)
Master of Science (Mention specialization: __________________________________________)
PhD (Mention specialization: _____________________________________________________)
Do you have a degree/diploma in education?
 Yes
 No
If your response was yes, specify which of the following you have completed:
 BA in Education (Elementary education focus science/mathematics; Other)
 Teaching Diploma (Elementary education focus science or mathematics)
 Teaching Diploma (Middle/Secondary education focus science/mathematics)
 MA in Science/Mathematics Education
 Other (please specify): _________________________________________
Have you ever attended workshops or any other type of professional development?
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Yes
No
If your response is yes, specify how many workshops, on the average, you attend per year:
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1
2
1-3
3–5
More than 5
Have you ever offered workshops or developed materials for professional development?
 Yes
 No
If your response is yes, specify the type of workshops/professional development materials that you
offered/ developed previously:
Application Form page 3
Have you ever participated in a research study about teaching and/or learning science or mathematics?
 Yes
 No
If your response is yes, specify the purpose of those research studies and the nature of your involvement:
Explain why you are interested in participating in this summer institute:
Application Form page 4
In addition to the five-day summer institute, participants will be invited to participate in a research study
about issues related to teaching science and mathematics in multilingual contexts at some point after the
training. Would you be interested in participating in such a research project?
[NOTE: If you indicate ‘yes’ here this is not a commitment and more information about the study will be
provided with a formal invitation to participate in the study. For now we are interested in knowing if this
is something you might be interested in.]

Yes

No
Describe why you might be interested to participate in a research study about teaching science and
mathematics in multilingual contexts.