PAN 2011 Instructor Application

July 31-August 5, 2011

Michigan State University

This continuing education program is intended
for science teachers at the middle- or high-school level.


| PAN Home Site |

Note: Due to a technical problem, we were not able to receive
applications that were submitted on or before March 14, 2011.
If you submitted an application before this date, please complete
and submit the application again. Sorry for the inconvenience.


Information about you

First Name:

Last Name:

Email:

Phone:

Home address street:

City: State: ZIP:

Gender (optional):

Male

Female

 

Information about your school

School Name:

School District:

   

School Phone:

School address street

City: State: ZIP:

Information about your background

Degree

Major/minor

Institution

Degree

Major/minor

Institution

Current Teaching Load (subject, # of classes, # of students)


Please list all subjects you have taught in the last five years.


Please list any other relevant laboratory work experience.


Please state briefly why you are interested in the PAN program. You can also
send your personal statement to PAN, or e-mail it separately.


Professional references

Please list two professional references whom we may contact.

Name

Title

Affiliation

Phone number

Name

Title

Affiliation

Phone number

Accommodations and students

Do you plan to stay on campus?

Yes No

If no, please tell us how you will get to MSU and where you will stay.

Survey

How did you first learn about the PAN program?

Poster        The PAN website

Another website (please specify):      Other (please specify):