CSULB Elementary Science & STEM Leadership Academy
June 27 – July 8, 2016 plus 15 hours during the 2016-2017 School Year
In order to maximize program impact, priority will be given to pairs or teams of teachers from the same school.
Applications will be accepted & reviewed until all spots are filled. We will begin reviewing applications May 1st.
Name:________________________________________________________________________________________ Date_____________________________
Address:________________________________________________________________________________________________________________________
Street (Apt) City, State Zip
Contact Information:_(______)________________________(_____)_________________________________________________________________
Home Telephone Cell Phone E-mail
School District/School______________________________________ Type of CA Credential held:__________________________________
Grade you are teaching: __________________ Total Years of Teaching Experience: _____________________________
Who else from your school is applying?___________________________________________________________________________________
Science Textbooks/Instructional Materials used in your classroom: _____________________________________________________________________________________________________________
You application consists of this cover sheet, a copy of your resume/CV, a list of any science professional development you have participated in during the past three years, and an essay (not to exceed one page, single spaced) explaining why you should be accepted into this program.
_____________________________________________________________________________________________________________
I understand that I am making a commitment to a two week summer workshop as well as a minimum of 15 hours of ongoing professional development which will be offered during the year. I also understand that access to my CST scores will be needed.
_________________________________________________________ __________________________________
signature date
For Your Principal only:
___________________________________________ teaches _________ grade(s) and is a staff member in good standing. To the best of my knowledge, this teacher will be re-employed by the district for 2016-2017.
______________________________________________________ __________________________________
Principal signature date
______________________________________________________
School District/School
You can scan this application and email to laura.henriques@csulb.edu or send to:
Laura Henriques
Science Education Department
California State University, Long Beach
1250 Bellflower Blvd.
Long Beach, CA 90840-4506
562-985-1408
This program is funded by Richard D. Green.
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