Lake Huron Watershed Place-Based Education Summer Teacher Institute
UofM Biological Station - Pellston, MI
August 5-8, 2013
Teacher Application /

A hands-on learning experience for teachers and informal educators engaged or interested in enhancing learning through Great Lakes and natural resource stewardship education and applied place-based practices.

Stipends supporting teacher’s involvement in training and implementation of planned place-based education projects are provided by a grant from the U.S. Environmental Protection Agency.

·  Workshop Participation Stipends ($200) are intended to encourage and support the participation of educators in this place-based education workshop; so that they can enhance their understanding of current Great Lakes issues and science, develop their Great Lakes science education network, and advance Great Lakes Literacy in their classroom, school, district or informal education setting.

·  Additional Project Development Stipends (up to $500)are available to participants who complete training, including development of a place-based

Application consists of:

1.  This form, with all sections completed. Incomplete applications will not be considered.

2.  Statement of your intended applications of place-based education strategies and integration of Michigan’s Great Lakes and natural resource stewardship as part of teaching (last section of this form).

ENROLLMENT IS LIMITED! APPLY BY MAY 17, 2013!

Funding for this workshop and teacher stipends provided by the Great Lakes Restoration Initiative and the Great Lakes Fishery Trust’s Great Lakes Stewardship Initiative

MSU is an affirmative-action, equal opportunity employer. Michigan State University Extension programs and materials are open to all without regard to race, color, national origin, gender, gender identity, religion, age, height, weight, disability, political beliefs, sexual orientation, marital status, family status, or veteran status.


2013 Lake Huron Place-Based Education

Summer Teacher Institute

Application Form

PERSONAL INFORMATION

Prefix (Choose one) Dr., Mr., Mrs., Ms.

First Name: / Last
Name:
Home Street Address:
City: / State: / Zip Code:
Home
Phone: / Email Address:
Teaching Certification Field/
Years of Teaching Experience:

SCHOOL INFORMATION

School Name & District:
If a Charter School,
list charter sponsor:
School Address:
City: / State: / Zip Code:
School Phone: / School Fax:

DEMOGRAPHIC INFORMATION

School community (Circle one): / Urban / Suburban / Rural / Tribal
Grade level/s you teach: / 4 / 5 / 6 / 7 / 8 / 9 / 10
Subject/s currently teaching:
Average number of students in each class:
Diversity of school population (Percentages):
American Indian or
Alaska Native / % / Asian: / % / Black or
African American: / %
Native Hawaiian or
Other Pacific Islander / % / White: / % / Hispanic/Latino ethnicity: / %
Free/reduced lunch / % / English language learners (ESL) %


OPTIONAL DIVERSITY INFORMATION:

·  Check the appropriate box(es) as to what race you consider yourself to be:

 American Indian or Alaska Native  White

 Black or African American  Asian

 Native Hawaiian or Other Pacific Islander

·  Ethnicity (check one):

 Hispanic or Latino  Not Hispanic or Latino

 Do not wish to provide

Food & Lodging (all rooms are double occupancy)

LODGING: all rooms are double occupancy; please indicate if you have any special accommodations needs or requirements so that we might make arrangements with facilities.

MEALS: All meals are provided as part of workshop; however please indicate if you have any Special Dietary Needs(?):

Introduction to Place-Based Education PRIMER SESSION:

Introduction to PBE (12-5:00 Aug 5) is required for individuals who have not previously attended a Summer Institute.

I will be attending the Intro to PBE Yes[ ] NO[ ]

ADMINISTRATOR REFERENCE & PERSONAL STATEMENT:

REFERENCE:

Name of Administrator:

Administrator Phone Number:


PERSONAL STATEMENT

Describe why you feel this program would benefit you as a professional. Describe how you plan to integrate this experience within your classroom instruction and community. Please limit your response to 300 words.

APPLICANT SIGNATURE:

Signature of Applicant

Date

Send the completed application only by email to Brandon Schroeder (). All application materials must be received by Friday, May 17, 2013 by 5p.m. EST. Applicants will be notified of selection by Friday, May 31, 2013.