Final as of 022609- 2009 T-l Dvin Appl (11)
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STUDENT DEMOGRAPHICSPlease identify your student population by
SettingUrban _________Rural _________Suburban _________
EthnicityAfrican American/Black, No Hispanic _________Native American/Indigenous _________Hispanic _________Asian _________Pacific Islander _________White, No Hispanic _________Other (Please specify) _________
GenderMale Students _________Female Students _________
Socio-economic statusWhat percent of students qualify for Free or
Reduced-Price Meals or meet other indicators oflow socio-economic status?________________________________
OUTREACH WORKSHOP COMMITMENT STATEMENTAfter participating in the 2009 National Biotechnology Teacher-LeadProgram, I commit to provide an outreach session to colleagues andprovide to DVIN a lesson plan for students by December 31, 2009.
_____________________________________________________________________________Signature
What Do I Need to Send to Complete My Appl ication?
Place the following in one envelope: Completed application Cover letter Letter of recommendation and commitment from your department
chair/supervisor A summary of your outreach session plan
Where Do I Send the Application Materials?Mail the envelope postmarked no later than Friday,March 20, 2009
To:
2009 National Biotechnology Teacher-Leader ProgramBiotechnology Institute2000 N. 14th Street, Suite 700
Arlington, VA 22201
By Fax: 703-248-8687
REMINDER: Only complete applications with all required supportingdocumentation will be considered.
Who May Apply?
High school and two or four-year college educatorsactively engaged in teaching students in life scienceand biotechnology classrooms.
How Do I Apply?
Step 1:Complete the application form
Step 2:Contact your supervisor to discuss how thetraining will be implemented into yourclassroom teaching and provide thisinformation in a cover letter to us
Step 3:Obtain a letter of recommendation from yourdepartment chair/supervisor that includes thedepartment chair/supervisors commitment toprovide time and/or a substitute teacher foryou while you attend the Conference
Step 4:Develop an outreach session planfor the session you will conduct for your
colleagues fall 2009
Superintendent Information
___________________________________________Name of Superintendent/ Department Chair
___________________________________________County/State
___________________________________________Address
___________________________________________City State Zip
___________________________________________Office Fax
___________________________________________Email
Criteria for Selection
1. Commitment from your supervisor toparticipate in the Teacher Leader Program
2. Your commitment to conduct an outreachsession for your colleagues by December 31,
2009
3. Your commitment to provide a lesson plan toteach students based on the learningconcepts taught in the Teacher- Leaderprogram to DVIN to post on the DVIN websiteby December 31, 2009
Whom Do I Contact if I Have Questions?For further information, please contactTom Keller at 703.248.8681 orvia E-mail: [email protected]
mailto:[email protected]:[email protected]
