Last Name *

First Name *

Middle Name

Home Address *

City, State, Zip *

Country

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? *

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. *