H.S. Chemistry Teacher Workshop Application

Application for High School Teachers wishing to attend
Ohio Northern University's Chemistry Teacher Summer Workshop.

Last Name: *

First Name: *

Email Address: *

Phone Number: *

Street Address for Mail: *

City: *

State: *

Zip Code: *

Education

College Major: *

Please list your most relevant college major (e.g. chemistry, physics)

Undergraduate Degree (e.g. BS, BA, Associate): *

Year of Undergraduate Degree: *

Area(s) of Teaching Certification: *

List other degree(s), field, and year earned:

Teaching Experience

School/Institution: *

Please list the school where you currently teach.

City/town where you teach: *

State where you teach: *

Years teaching experience at the high school level: *

Do you teach AP Chemistry?: *

Yes

Courses taught over the past 2 years: *

Include the Course, number of students, and associated laboratory hours.

Please upload your essay (accepted formats: txt, rtf, pdf, doc, docx, pages). Make sure the name of your file contains your name.: *

Provide a short statement (250-500 words, 1-2 pages) that describes why are you interested in attending this Chemistry Teacher Workshop, how it will contribute towards your professional goals, and how it will benefit your chemistry program. Please make sure the name of your file contains your name. It is also helpful to have your name at the top of the paper as a header or as the title.

How did you hear of this program?: *