Ohio Physics/Physical Science, Chemistry, & Biology Modeling Workshops
(Mon - Fri June 12 – 30, 2017 at New Albany High School;
sponsored by the Improving Teacher Quality Program of the Ohio Dept. of Higher Ed.,
South-Western City Schools, New Albany Plain Local Schools, and The Ohio State University)
APPLICATION
(Review of applications will begin March 17, 2017
and continue until all spots are filled.)
Please indicate your first workshop choice: [ ] physics [ ] chemistry [ ] biology
If your first choice is full and you have a second preference, please put it here: ______
NAME E-MAIL
FIRST MI LAST
SCHOOL NAME ______
SCHOOL ADDRESS
NUMBER AND STREET CITY, STATE, AND ZIP CODE
HOME ADDRESS
NUMBER AND STREET CITY, STATE, AND ZIP CODE
HOME PHONE ______SCHOOL PHONE ______
BA or BS major field ______Year ______
MA or MS major field______Year ______
TEACHING EXPERIENCE (List your last position first.)
School and location from to Subjects taught
Please attach a short statement (one page or less) describing why you would like to participate in this workshop.
(application continued on reverse)
Are you willing to attend a three-week summer workshop and three Saturday follow-up sessions scheduled during the school year? ______
Are you willing to give your students a conceptual test provided by the workshop staff next year as a pre-test and post-test? ______
Are you willing to participate in a local Modeling teachers’ e-mail listserv? ______
Are you currently planning to register for graduate credit (tuition paid by the grant)? ______
We have funds this year to greatly defray the housing cost for those outside the Columbus area.
Would you like us to send you further information about the housing? ______
There is a $35 application fee. The only circumstance under which it will be returned is if you are not offered a spot in a workshop.
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COMMITMENT FROM YOUR PRINCIPAL (or other appropriate administrator)
Are you willing to support this teacher in implementing Modeling instruction in his/her classroom? ______
______
Administrator’s signature Title date
______
Administrator’s printed name
Address______Phone ______
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A complete application includes 1) this form, fully completed with administrator signature
2) short statement (see bottom of page 1)
3) check for $35 made out to
OSU EED Teachers Workshop
Return application to
Dr. Kathy Harper
Department of Engineering Education
244 Hitchcock Hall
2070 Neil Ave
The Ohio State University
Columbus, OH 43210
QUESTIONS: e-mail or call Kathy at (614) 688-7538