Summer 2014
Hands On! Hearts On! Minds On!
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Teacher Application

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Last Name *

First Name *

Middle Name

Home Address *

City, State, Zip *


Home Phone *

Email Address *

Social Security Number (123-45-6789) *

Principal *

School Name *

School Address *

School City, State, Zip *

School Phone *

Current Teaching Position *

Years at this job *

University/College attended *

Highest Degree *

Major *

Date degree was granted *

Do you have a teaching certification (Yes/No)? *

If yes, please describe?

June - August Address and Phone
(if different from above)

List previous teaching or related experience, length, and include a brief description of courses taught. *

Describe your outside activities and hobbies. *

What special talent or resource will you bring to the TEWS-Space Race summer camp? *

How do you hope to benefit from working at the camp this summer? *

Which of the following potential Discovery Topics™ particularly interests you? *

Design an exercise program and equipment to keep teenagers healthy on Mars.
Food? What are we going to do for food on the way to Alpha Centuri?
A modern day Noah's Ark: What to do in case of a planetary disaster.
Explain the value of COBE, Hubble Space Telescope and why should we want to know how planets were formed.
Should we try to develop a weather machine?
Design the air transportation system for 2050.
Finding Worf: Is there intelligent life elsewhere in the universe?
Design a remote sensing system to improve health in the development of the least developed countries on earth.
Let‘s talk to each other. Design a “low cost” communications system for isolated areas.
Solve this problem: How many people can the Earth hold?
Design a mission to the Sun.
Design an energy system to power our trip to Io.

Why do the above Discovery Topics™ interest you? What might be your approach? *

Explain the importance of STEM literacy in our world today and in the years to come. *

If there is a question we should have asked or a comment you would like to make, please feel free to respond. Likewise, if you have answers to any of the following questions, we would love to hear them. Are there any field trip ideas that you have that we should try to organize? Are there particular experiments or activities that you think we ought to consider in our curriculum development? *

Please list three references. *

By submitting this application, I do hereby authorize The Dorothy Jemison Foundation for Excellence (DJF) to perform a background check, including, but not limited to, a criminal, employment, and/or academic achievement.  I acknowledge that I am applying to be a consultant/sub-contractor and that this information may, and can, be used to influence decisions on my selection.  I agree that this authorization is effective immediately and will continue until such time as the TEWS - Space Race 2014 project is complete and/or I notify DJF, in writing, that I withdraw this authorization.  I certify that the information provided is true and complete to the best of my knowledge.