Mars Revealed: Evolving Technology, Advancing Science
A Five-Day Training for High School Teachers

July 22 – 26, 2013
Lunar and Planetary Institute, Houston, TX

Sponsored by the ChemCam Instrument on the Mars Science Laboratory and the LPI

ELECTRONIC APPLICATION FORM

Thank you for your interest in the Mars Revealed: Evolving Technology, Advancing Science workshop. Please note that registration is limited to 20 participants and restricted to high school teachers (both those currently teaching high school and those preparing to teach high school). Stipends are available for 15 participants and will be offered on a first-come-first-accepted basis. Within five business days of receiving your application, you will receive notice of your application's status, from Andy Shaner (281-486-2163; shaner@lpi.usra.edu).

First Name:

Last Name:

What name or nickname do you prefer for your badge?

Work Address

School / Affiliation:

Address(1):

Address(2):

City:

* State: * Zip:

Country:

Work Telephone:

Work E-mail:

Re-confirm Work E-mail:

Home Address (or summer contact information):

Address(1):

Address(2):

City:

* State: * Zip:

Telephone:

E-mail:

Re-confirm Home E-mail:

Grade level and subjects you are currently teaching, or expect to teach:

What specific Earth and space science topics do you currently cover in your classroom?

What is your comfort level with teaching science?
Very Comfortable
Comfortable
Moderately Comfortable
Slightly Uncomfortable
Very Uncomfortable

Please estimate student diversity in your school:

% Hispanic	% African American	% Caucasian	% American Indian	% Asian	% Other

How would you classify your school environment?

Rural Urban Suburban

What is the classification of your school?

Public Private

How would you classify the community income level?

upper upper-middle middle lower-middle lower

What are your objectives in attending this workshop? Please list all (professional development hours, new techniques to use the classroom, encouragement from colleagues or administration, meeting and hearing from research scientists, enjoyment of science/astronomy/lunar science, etc.)

How did you hear about this workshop? (pick all that apply)
Another teacher
An administrator
An email from LPI
A NASA website or email
Other. Please specify:

Additional Comments:

The Lunar and Planetary Institute has a monthly education email newsletter with information about upcoming workshops, resources, grants, news, and more that we would like to send to you; it can be viewed here. Please check here if you'd like to opt out of receiving this monthly email).
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For further information, contact:
Andy Shaner
Lunar and Planetary Institute
3600 Bay Area Boulevard
Houston, TX 77058
281-486-2163
shaner@lpi.usra.edu

Mars Revealed: Evolving Technology, Advancing Science A Five-Day Training for High School Teachers

July 22 – 26, 2013 Lunar and Planetary Institute, Houston, TX

Sponsored by the ChemCam Instrument on the Mars Science Laboratory and the LPI ELECTRONIC APPLICATION FORM

Mars Revealed: Evolving Technology, Advancing Science
A Five-Day Training for High School Teachers

July 22 – 26, 2013
Lunar and Planetary Institute, Houston, TX

Sponsored by the ChemCam Instrument on the Mars Science Laboratory and the LPI

ELECTRONIC APPLICATION FORM