La Main À La Pâte (Www

REGISTRATION FORM

Double applications (2 persons from the same country, 1 trainer and 1 decision-maker) are required; the profile of the participants have to be complementary to guarantee a better transfer within their national system.

The priority will be given to persons belonging to organisations which have not been represented yet in the previous seminars.

Please fill the different sections on computer, word format (not handwriting) and send it back to ,before the 28 th of February, 2018.

PARTICIPANT 1:

I. Information on the participant:

Family name of the participant:______

First name of the participant:______

Date of birth:______

Position of the participant: ______

Organisation Name: ______

Specific unit or department involved inside your organisation:

______

Organisation address: ______

Zip Code:______City:______

Country: ______

Phone Number: ______

E-mail: ______

Status of your organisation:

●Non-profitorganisation: _Yes _ No

●Public body: _ Yes _ No

●Research organisation: _ Yes _ No

●Higher or secondary education institution: _ Yes _ No

Participant’s careerconcerning science education in school (in a maximum 3 lines):

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Spoken languages(English or/and French)? Level from 1 to 5 (1 is beginner and 5 is expert):______

Do you have a particular diet (allergies, vegetarian, halal (but you eat fish?) ? :______

In the review of your application,special attention will be paid to the impact that your participation could have on national initiatives in favour of science education in your country (public policy, teacher training institutions, pilot programs).

II. Motivation and interest for the dissemination of the La main à la pâte program

Answer these questions (5 lines max):

1 - Do you already know“La main à la pâte”? If yes, how?Do you know other similar programs? If yes, which one?

2 - What professional experience do you have ininquiry-based science education?

3 - What actions have you conductedin the last 12 months concerning inquiry-based science education (professional development sessions, research, projects implementation…)?

4 - What are your motivations to participate in this seminar?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

5-Do you think that you could contribute to the dissemination of an inquiry-based science education in your country? If yes, how? If no, why?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

6-Is your action part of a national science education program in your country? If yes, could you describe this program as well as your partners?

7 - Could you position yourself on this diagram concerning the development of your project, on each item? (1 for beginner, 3 for expert)

8- Are you more interested by primary education (3-10 year-old) or secondary education (11-14 year-old)?

………………………………………………………………………………………………………………………………………

CALENDAR AND SELECTION OF CANDIDATE

To participate in this seminar, the candidates have to fill the registration form above(on a computer, in word (.doc) format) and the joined affidavit below and send them back to Ms Anne Lejeune,before February 28th, 2018. Special care must be paid to the accuracy of the information supplied.

The selection of the beneficiaries will be made on the beginning of March. The results will be announced,from March 16th, 2018. The selected participants will receive an individual confirmation by e-mail.

To validate their registration, the participants will have to send the copy of their plane ticket (not only thepre-booking) before April 31st, 2018, strict deadline. Without this document, their applicationwill not be accepted.

______

AFFIDAVIT

This certificate is to be signed, scanned and sentbefore February 28th, 2018, to Anne Lejeune -

I the undersigned … … … … … … …… …… …… …, working for … … … …… …… …… …… … …, certify:

- To be acquainted with the conditions of participation and the contents of the international seminarof La main à la pâte 2018 such as described on the website

- To be acquainted with the fact that the international travel costs, airport transfers, health care and visa feeswill have to be paid by me or my institution;

- To be acquainted with the fact that some dinner costs will have to be paid by me or my institution;

- To be in condition, because of my position, to disseminate the contents of this seminar within the educational system of my country and to convey all the relevant information to my colleagues;

- To be fluent in English or in French;

- To commit myself to take part in all the activities organised in the frame of the seminar.

Done in……………………..., the ………………………..

Signature ………………………..

REGISTRATION FORM

Double applications (2 persons from the same country, 1 trainer and 1 decision-maker) are required; the profile of the participants have to be complementary to guarantee a better transfer within their national system.

The priority will be given to persons belonging to organisations which have not been represented yet in the previous seminars.

Please fill the different sections on computer, word format (not handwriting) and send it back to , before the 28 th of February, 2018.

PARTICIPANT 2:

I. Information on the participant:

Family name of the participant: ______

First name of the participant:______

Date of birth:______

Position of the participant: ______

Organisation Name: ______

Specific unit or department involved inside your organisation:

______

Organisation address: ______

Zip Code:______City: ______

Country: ______

Phone Number: ______

E-mail: ______

Status of your organisation:

● Non-profit organisation: _ Yes _ No

● Public body: _ Yes _ No

●Research organisation: _ Yes _ No

● Higher or secondary education institution: _ Yes _ No

Participant’s careerconcerning science education in school (in a maximum 3 lines):

Spoken languages (English or/and French)? Level from 1 to 5 (1 is beginner and 5 is expert):______

Do you have a particular diet (allergies, vegetarian, halal (but you eat fish?) ? :______

In the review of your application, special attention will be paid to the impact that your participation could have on national initiatives in favour of science education in your country (public policy, teacher training institutions, pilot programs).

II. Motivation and interest for the dissemination of the La main à la pâte program

Answer these questions (5 lines max):

1 - Do you already know“La main à la pâte”? If yes, how? Do you know other similar programs? If yes, which one?

2 - What professional experience do you have in inquiry-based science education?

3 - What actions have you conducted in the last 12 months concerning inquiry-based science education (professional development sessions, research, projects implementation…)?

4 - What are your motivations to participate in this seminar?

5 - Do you think that you could contribute to the dissemination of an inquiry-based science education in your country? If yes, how? If no, why?

6 - Is your action part of a national science education program in your country? If yes, could you describe this program as well as your partners?

7 - Could you position yourself on this diagram concerning the development of your project, on each item? (1 for beginner, 3 for expert)

8- Are you more interested by primary education (3-10 year-old) or secondary education (11-14 year-old)?

………………………………………………………………………………………………………………………………………

CALENDAR AND SELECTION OF CANDIDATE

To participate in this seminar, the candidates have to fill the registration form above (on a computer, in word (.doc) format) and the joined affidavit below and send them back to Ms Anne Lejeune, before February 28th, 2018. Special care must be paid to the accuracy of the information supplied.

The selection of the beneficiaries will be made on the beginning of March. The results will be announced, from March 16th, 2018. The selected participants will receive an individual confirmation by e-mail.

To validate their registration, the participants will have to send the copy of their plane ticket (not only the pre-booking) before April 31st, 2018, strict deadline. Without this document, their application will not be accepted.

______

AFFIDAVIT

This certificate is to be signed, scanned and sent before February 28th, 2018, to Anne Lejeune -

I the undersigned … … … … … … …… …… …… …, working for … … … …… …… …… …… … …, certify:

- To be acquainted with the conditions of participation and the contents of the international seminar of La main à la pâte 2018 such as described on the website

- To be acquainted with the fact that the international travel costs, airport transfers, health care and visa fees will have to be paid by me or my institution;

- To be acquainted with the fact that some dinner costs will have to be paid by me or my institution;

- To be in condition, because of my position, to disseminate the contents of this seminar within the educational system of my country and to convey all the relevant information to my colleagues;

- To be fluent in English or in French;

- To commit myself to take part in all the activities organised in the frame of the seminar.

Done in……………………..., the ………………………..

Signature ………………………..