Teacher Institute Registration

    Personal Information

    Your Name (required)

    Home Phone (required)

    Cell Phone

    School Phone

    Home Email (required)

    School Email

    Your Address:

    Street (required)

    City (required)

    State (required)

    Zip Code (required)

    Skills & Certifications

    Degree(s) Awarded

    Certification(s) Awarded

    Area of Specialty (ex. Social Studies, Science, etc.

    Number of years teaching (required)

    Grade Level

    School Information

    Name of School

    School District

    School Address:

    Street (required)

    City (required)

    State (required)

    Zip Code (required)

    Your Goals

    Please describe in 250 words or less:

    A) Describe the ways you would like to improve your teaching skills and historical knowledge by attending this institute?

    B) Give examples of how you have worked collaboratively or creatively to develop educational experiences for students.