Please enter all the information requested below. To complete the form you must enter all information.
Name
Title: First: Last:
Home Address
Street: City: Zip: Home Phone number email address:
City:
Zip: Home Phone number
email address:
Teacher Status Data:
Teaching Experience: 1 year 2 years 3 years 4 years 5+ years
Grade(s) currently teaching:
School:
Name :
Address:
Street: City: Zip: Phone number
Zip: Phone number
Certification:
Permanent Provisional Temporary
Current Certification Area (Level and/or Subject):
Education Information:
Undergraduate degree/program School
Graduate degree/program School
Date received or expected:
Have you ever taken a graduate course at Buffalo State College? yes no
If so, what semester/year?
Teacher Technology Data:
Number of computer(s) that you have in your classroom:
Type and model of computer(s) that you have in your classroom:
Rate yourself on your computer experince:
Number of graphing calculator(s) that you have in your classroom:
Type and model of graphing calculator(s) available to use in your classroom: TI 73 TI 83 Casio none other
Rate yourself on your graphing calculator experince:
CONTRACT STATEMENT
I agree to the following commitment:
· to attend all six days of the I 2T 2 Summer Institute, August 17 - 22, 2009, 8 a.m. to 4:30 p.m., at Buffalo State College;
· to work with preservice mathematics teachers from Buffalo State College, which will include being observed and/or serving as a cooperating teacher for student teachers
· to attend seven hours of inservice classes during the fall semester, time and dates to be determined.
· to create a technology-enriched lesson plan and vidoe tape the implementation of it in my classroom, incorporating the philosophy and materials provided by this project, to be shared via the project website; and,
· to provide inservice or mentoring for other teachers in your school as requested by your principal or teacher center.