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Fax to (415) 337-5205 or send to Project ASTROTM Applications, ASP, 390 Ashton Ave., San Francisco, CA 94112 The 2016 Project ASTROTM introductory workshop will take place September 16-17, 2016 (Friday and Saturday) Participating teachers and astronomers are required to attend.

Teacher Application - return by August 22, 2016 Personal Information
Name _____________________________ Address ___________________________ City ______________________________ State ________ Zip _________________ Home Phone _______________________ E-mail ____________________________

School/Organization Information
Name _____________________________ Address ____________________________ City _______________________________ State ________ Zip __________________ Phone _____________________________ E-mail _____________________________

Ethnicity (optional)________________ Best way to contact you: home email work email home phone work phone other

SCHOOL DEMOGRAPHICS (you must complete this section to be eligible) School type: public private after-school rural suburban Estimated percentage of students who will be in your class who are: ____ receiving free lunch ____ minority members ____ females Describe the type and amount of science resources available at your school:

urban

___________________________________________________________________ _____ Teacher Background ~ Help us make a good match!
Please briefly describe your educational background, including any science-related studies.

_______________________________________________________________________ _______________________________________________________________________
Relevant teaching experiences: Please include professional development activities, curriculum development, in-service activities, and collaborative projects.

_______________________________________________________________________ _______________________________________________________________________ Grades and subjects you will be teaching next year____________________________________
Years of teaching experience ___________________________________________________ What language(s) do you speak? ________________________________________________


Astronomy-related Experience
Have you taught astronomy before? yes no If so, for how long? ______________________

Working with Project ASTRO
Why are you interested in working with Project ASTROTM? ______________________________________

__________________________________
Please list any other astronomy or science activities in which you are involved. ______________________________________ How will you include astronomy in your curriculum in 2016-17? as a unit integrated during the year both other _________________________ Do you have flexibility to teach astronomy at any time during the year? yes no If no, please explain: ________________________________________ ________________________________________ ________________________________________ If yes, please explain:

__________________________________
When during the year do you plan to teach astronomy (approximate months)? ______________________________________ How would you rate your astronomy knowledge? Limited.....1.....2.....3.....4.....5...6....Extensive

Have you had experience with classroom volunteers? yes no

_____________________________________________________________________ _____________________________________________________________________
How did you hear about Project ASTROTM? _____________________________________________ I agree to attend the September 1.5-day workshop and understand that if I am unable to attend, I will not be eligible to participate in Project ASTROTM. Astronomers and teachers are required to commit to at least 4 classroom visits per academic year. By signing this form, I certify that the above statements are true, and that I am able and willing to accommodate such visits during the 2016-2017 academic year. Signature ___________________________________________ Date ___________________
If you have any questions call (415) 715-1426, or e-mail bayareaastro@astrosociety.org.

Administrator support leads to more successful partnerships. Please have the appropriate administrator in your school or district, or Executive Director, certify support for your participation in Project ASTROTM by completing and signing below. Unsigned applications will not be accepted. ADMINISTRATOR SUPPORT (Required) I will support the participation of (applicant) __________________________________________
in Project A STROTM. I understand that a local astronomer will be visiting our school/organization.

Our school/organization will contribute $ _____ ($100 recommended) to cover registration and materials for
the 1.5 -day workshop. *Note: No one will be excluded because of lack of funds, but contributions to help our project continue are appreciated.
If your school/organization would like to contribute funds to the program, please make the check payable to the Astronomical Society of the Pacific, and either submit it with your application, or bring it to the September workshop. Thank you.

Signature _____________________________ Date______________ Phone ( ) ______________ Name (print) ________________________________ Title _________________________________