2023 Teaching Institute Registration

Personal Info

First Name

Last Name

Mobile

Select Work or Personal Email

Please select... Work Personal

Work Email

Personal Email

Gender

Please select... Female Male Non-Binary Prefer Not To Say

Which of the following best describes the your race/ethnicity

Please select... Asian Black or African American Biracial or Multiracial Hispanic or Latino Indigenous American or American Indian or Alaska Native Native Hawaiian or other Pacific Islander White or Caucasian I would rather not say Other

Please describe your race

How did you hear about us?

Please select... Friend My Employer Project Scientist Event Project Scientist Newsletter Project Scientist Website School Advertisement Social Media Other

If Other, How did you hear about us?

Which Social Media Platform?

Please select... LinkedIn Facebook Instagram Twitter TikTok

Mailing Address

Street Address	City
State Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau	Postal Code

Teaching Institute Info

Please select the Teaching Institute Workshop(s) you would like to sign up for:

Saturday, April 29th: Culturally Responsive Math Teaching Saturday, June 3rd: SciGirls Gender Equity Training for STEAM Educators 

** Both Workshops will be held from 9a to 3pm CST**

How would you like to be compensated for attending a Fall or Spring in-person workshop?

Please select... In-Person attendance stipend CEUs

What are you most interested in learning? 

For workshop programs there are reflection assignments and surveys. Please be prepared to complete those items. Do you have any barriers to completing these items?

Please select... Yes No

If yes, please explain. 

Do you have any experience with any of the listed strategies? Select all that apply

SciGirls	Culturally Responsive Pedagogy	Teaching for Equity
Antiracist Teaching	Virtual Teaching	None

Approximately, how many different students do you typically teach per school year (Overall Total during Summer, Fall and Winter)?

Enter one numeric value ONLY!

What else would you like to share regarding your availability, interest, or something else? 

Please list any food/dietary restrictions you may have.

Professional Experience

What is your current professional role? 

Please select... Certified Teacher Paraprofessional Administrator Other

If other title please explain

Select the grades you have taught: Select all that apply 

P-K	1-2	3-4	5-6
7-8	9-12	Other	None

Select the subjects you have taught: Select all that apply 

Science	Math	Technology	Engineering
Non STEM classes	None

What non STEM classes have you taught?

School Info

School Name

School Address

City

State

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Postal Code

Does your school host after-school or summer programming?

Please select... Yes No I don't know

Does this school have a Title 1 designation:

Please select... Yes No I don't know