WWNFFTEACHERSCOMMUTER
NEW YORK CITY COMMUTER INSTITUTE APPLICATION
Sponsored by the American Museum of Natural History; Pace University; and the Woodrow Wilson National Fellowship Foundation Leadership Program for Teachers.

Orientation July 27, 2001;
Institute runs Monday through Friday July 30 - August 10, 2001.

INSTRUCTIONS:

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PERSONAL INFORMATION
First Name, Last Name, Suffix (i.e. jr)
Preferred form of address: Mr. Mrs. Ms. Dr.
Home Address (include zip):


City
  Zip Code

Home Telephone:
Social Security Number:
Ethnicity: (optional information) Select the race with which you most closely identify.
African American
American Indian or
      Alaskan Native
Asian or Pacific
      Islander
Hispanic
White
         (not of Hispanic origin)
 Multi-Ethnic:
Internet accessibility:
(check all that apply)		 Home School Other:
Preferred e-mail address:
Other e-mail address:
I check my e-mail: Daily Weekly Monthly Never

How did you learn about the Leadership Program for Teachers?

Direct mailing Administrator
Website TORCH workshop
Woodrow Wilson teacher Conference
If Conference (please specify):
           Other (please specify):
SCHOOL INFORMATION
Present teaching position:
Grades and subjects:
Number of years in science teaching:
School Name:
School Address (include zip):


Zip Code
School Telephone:
Fax:
Principal’s Name:
Superintendent’s Name:
School District:
District Address (include zip):




Zip Code

District Telephone:
Number of students enrolled:
less than 100 101-500 501-1000
1001-1500 1501-2500 more than 2500
Percentage of students who qualify for the federal free lunch program:
The student body of my school is approximately:
% African American % Hispanic
% American Indian or Alaskan Native % White (not of Hispanic origin)
% Asian or Pacific Islander % Multiethnic
EDUCATION AND EXPERIENCE
Undergraduate institution

Degree Year Major Minor
Graduate institution

Degree Year
Graduate institution

Degree Year
List any positions you have had in the science department:
(i.e., chair, coordinator, resource teacher, mentor teacher)
Describe any school or district activities directly related to science education:
(i.e., curriculum development, curriculum adoption, assessment development, professional development)
Do you belong to any of these science education organizations? Yes (check below) No
National Science Teachers Association American Chemical Society
National Association of Biology Teachers State Science Teachers
American Association of Physics Teachers Other
Have you made any science education presentations at state, regional or national conferences in the past five years? Yes (If yes, specify below) No
CONTENT AND PEDAGOGY
Describe the extent to which you have previously studied biodiversity and what aspects of it you would like to be teaching.
What about biodiversity do you want to learn?
In the New York City Commuter Institute, you will engage in scientific inquiry and explore the possibilities and implications of this approach. Please describe how you currently engage students in scientific inquiry in your own classroom.

Once You have reviewed your application you may press submit to send.