August 1-6, 2010 Michigan State University
This continuing education program is intendedfor science teachers at the middle- or high-school level.
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Information about you
First Name:
Last Name:
Email:
Phone:
Home address street:
City: State: ZIP:
Gender (optional):
Male
Female
Information about your school
School Name:
School District:
School Phone:
School address street
Information about your background
Degree
Major/minor
Institution
Current Teaching Load (subject, # of classes, # of students) Please list all subjects you have taught in the last five years. Please list any other relevant laboratory work experience. Please state briefly why you are interested in the PAN program. You can also send your personal statement to PAN, or e-mail it separately. Professional references
Please list two professional references whom we may contact.
Name
Title
Affiliation
Phone number
Accommodations and students
Do you plan to stay on campus?
If no, please tell us how you will get to MSU and where you will stay.
Survey
How did you first learn about the PAN program?
Poster The PAN website
Another website (please specify): Other (please specify):
