Participant Application Form
Educators Science and Mathematics Institute Series at Michigan Technological University
Aboard the Research Vessel Lake Guardian
Applications must be postmarked by Tuesday, April 2, 2002
Applicants are selected on a competitive basis by their responses in this application.
Please type or print clearly in ink, and attach additional pages for responses to questions. Duplicate as needed.
Registration: $430 covers lodging, meals, field trip transportation, and instructional materials for the one-week Institute. Payment of registration fees is due by May 31, 2002. Make checks payable to Michigan Technological University. Teachers should contact their local Eisenhower coordinator to inquire about the availability of Eisenhower funding to cover their registration fee.
Tuition Costs (ED 5601 – 3 credits):
Michigan residents - $684 for non-degree seeking; $1,341 for students enrolled in MTU graduate program.
Non-degree seeking students who have not previously taken courses at MTU must complete an application form ($30 application fee).
Non-Michigan residents - $1,695 for non-degree seeking; $2,751 for students enrolled in MTU graduate program.
** Scholarships for up to 65% of tuition costs may be available for Ecology of the Great Lakes Institute participants. Scholarship information provided upon request. Participants will be billed directly by Michigan Technological University for their tuition.
Social Security Number: ____________________________________________________________________
Home Address: ___________________________________________________________________________
Street City State Zip Code
Work Phone: (_____)_______________________ Home Phone: (_____)______________________________
Fax: (______)___________________________ E-mail: ___________________________________________
How often do you check your e-mail? __________________________________________________________
Place of Employment: ______________________________________________________________________
Employer’s Address: _______________________________________________________________________
Street City State Zip Code
Current Subject Areas Taught: ________________________________________________________________
Ages/Grades Taught: _______________________________________________________________________
Degree(s) Earned/Areas of Teacher Certification: _________________________________________________
Please respond thoughtfully to the following questions on separate sheets of paper. Responses must be typed and double-spaced with a maximum of one-page per question. Your selection for a fellowship is based on your completed application and your substantive responses.
1) Describe your professional goals for attending this Institute, including what you will contribute to it and what you will gain from the experience.
2) Briefly outline a proposed plan for using the knowledge and resources you will gain during this Institute in your curriculum or educational program in the fall of 2002.
I plan to take this Institute for (check one box):
š Non-degree seeking credit (i.e. for permanent teacher certification renewal)
š Currently enrolled in a graduate program at MTU
š Currently enrolled in a graduate program at another university: _______________________
š No credit
If selected to attend the Institute, I agree to:
1) Read and respond to all preparatory materials and communications prior to the Institute.
2) Fully participate in each day of the Institute and present a “Best Teaching Idea” to fellow participants.
3) Develop, implement and assess a teaching unit or educational program in the fall of 2002.
4) Allow my final teaching unit or educational program to be published in some format by Michigan Technological University.
5) The release of my name, address, and e-mail address to other participants in this Institute.
Western Upper Peninsula Center for Science, Mathematics and Environmental Education
P.O. Box 270 / 809 Hecla St.
Hancock, MI 49930
Participants will be notified by Friday, April 12, 2002 as to whether they are selected.
Selected participants will be required to complete and submit medical history and liability release forms.