Stanford University | Center for Probing the Nanoscale | Education | Summer Institute for Middle School Teachers

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Summer Institute for Middle School Teachers Application

Eligibility: The Summer Institute for Middle School Teachers is offered to middle school science teachers with an active school appointment.

Instructions:

Complete parts 1-30 of the online application below. You will receive an email confirming you application submission withing two days. If you have not received an application confirmation email after two days, please contact Tobi Beetz.

1. First Name

2. Last Name

3. I am a

4. Email Address

5. Home Mailing Address

City

State

Zip Code

Phone Number

6. Alternate Email Address

Questions 7, 8, and 9 are Optional.
(The following information is used by the NSF for statistical purposes only)

7. I am

8. Ethnicity

9. Physical Challenges or Special Needs, etc.

10. School Name

11. School Mailing Address

City

State

Zip Code

Phone Number

12. Principal's Name

13. School Type

14. Please list the breakdown of your school's student population by percentage
Caucasian
African American
Asian (including Asian Indians)
Hispanic
Pacific Islander
Other

15. Please provide the percent of your school's students on free or reduced lunch program

16. Total number of years teaching science at the K-12 level

17. Do you have a contract for next year?

18. If you will be at a different school next year please list that here

19. Number of years teaching at current school

20. List courses and grade levels you are currently teaching (indicate if labs are included)

Course name	Grade level	# of classes	Lab included?

21. What would you like to get out of the SIMST program?

22. Please list science education programs or workshops you have
attended in the last 5 years.

23. List your involvement in extracurricular science organizations
(e.g., advisor to student science clubs, member of NSTA, etc.)

24. What experience do you have in science curriculum development?
(At your site, within your district, at the state/national level)

25. Would you be willing to participate in follow-up sessions with your class and CPN personnel during the school year?

26. Undergraduate Institution You Attended

27. Major(s)

28. Degree earned and date of graduation (month and year)

29. Teaching Credential (subject, year received)

30. How did you hear about SIMST?