Our Place in Space 2008 Application Form
July 28 - Aug. 1 at Wall High School, Wall, SD

[Stipends, meals and rooms will be provided]

Application review begins June 2, 2008.  Space is limited.

Name (Last, Middle Initial, First): 

School Street Address: 

School City: 

School Zip Code: 

School Email Address:

Confirm School Email Address:

Home Street Address:

Home City:

Home Zip Code:

Home Phone:

Home Email Address:

Confirm Home Email Address:

Correspondence for this workshop will occur primarily through email.  Please indicate which email address you would like used for future communication:

Home School Do Not Use E-mail

Please list the courses you will likely be teaching during the 2008-09 school year:

Please indicated the average number of students you typically have in the classes you teach:

Please estimate the percentage of your students who come from an Hispanic/Latino culture:

Please estimate the percentage of your students who come from a Native American culture:

Please estimate the percentage of your students who come from an African-American culture:

Please list any other groups that you would like insights into their culture:

Please rate your NEED for physics/physical science content training:

High Medium Low

Please rate your NEED for chemistry content training:

High Medium Low

Please rate your NEED for life science/biology/ecology content training:

High Medium Low

Please rate your NEED for astronomy content training:

High Medium Low

Please write a brief statement of why you would like to participate in this workshop: