Application for Biology Van 2009 Summer Course

Please complete the entire form and mail, fax, or email to:

Dr. Karel Jacobs

Department of Biological Science

Chicago State University

9501 South King Drive / SCI 232

Chicago, IL, 60628

Phone: 773-995-2183, FAX: 773-995-3759, email: kjacobs@csu.edu

Dates and times of the course:

July 6 to 17, 2009

10 AM to 4 PM (10 days, 60 hours)

Credit:

Three (3) hours of undergraduate/graduate credit for Biology 4690/5690 (special topics) from Chicago

State University is available at no cost.  (NOTE: credit is awarded for the Fall 2009 semester.)

Stipend: $ 900 for program or ($15/hour)

Selection Criteria:

 We are looking for individuals who teach high school biology in the Chicago area that would like help incorporating inquiry-based science experiments into the classroom.   This course will incorporate biology content theory and participants will be awarded a pass-no pass grade. 

Deadline for application:

The Deadline for application (below) is June 30, 2009, but applications are coming in quickly and are chosen on a first-come first serve basis.

Name: ____________________________________________________________________________ 

Home Phone: _______________________________________________________________________

Email address: ______________________________________________________________________

Social Security Number: _______________________________________________________________

(If you are uncomfortable providing this information on this application you can provide it at a later date.)

Home Address:

Street: __________________________________________________________________________

City: ___________________________      State: __________________      Zip: ________________

 School: _________________________________________________________________________

School Address:

Street: ___________________________________________________

City: ____________________________      State: __________________      Zip: ________________

School Phone:  ____________________________________________________________________

Are you certified in Biology?       Yes      No * 

 *If not, what certificate do you hold?

What courses are you currently teaching?

Do you currently conduct labs in your biology classes?        Yes    No  

If so, approximately how many labs do you do each semester?

How many years have you been teaching biology?

How many years have you been teaching?

Briefly describe why you would like to participate in the biology van program.

In-service teachers: In order to participate in the program we need to have your principal acknowledge the fact that you are participating.  

Principal acknowledgement of participation

__________________________________________                                           ______________________

Principal Signature                                                                                               Date