MSSA Research Experience Participant Registration

Applicant Information
 
First Name:
Last Name:
Home Address:
Home City:
Home State:
Home 5-Digit Zip Code:
Home Phone:
Cell Phone:
Personal Email:
School Information
 
School Name:
School Address:
School City:
School State:
School 5-Digit Zip Code:
School Email:
School Website:
 
Grade level(s) currently teaching: 6
7
8
Other:  
 
Subject(s) currently teaching: Earth & Space Science
Life Science
Mathematics
Physical Science
Other:  
 
School Technology Resources: Smart-board
Clickers (student personal response systems)
Laptop cart for students
Probeware
Graphing Calculators
Motion Dectors
PC in classroom
Mac in classroom
Windows XP Operating System
Mac OS X
LED projector in classroom
LED projector on a cart
Other:
 
Is your school urban, suburban, or rural?
Urban
Suburban
Rural
 
How many science teachers are in your school?
(numerical response only)
 
Applicant Education
 
Please List All Degrees Below
      Field:
      Field:
      Field:
      Field:
Other:        Field:
 
Previously enrolled as a University of Kansas Student? Yes    No
    If yes: Undergraduate    Graduate
 
    Last Semester and Year Enrolled:      
 
Did you have a prior career outside of K-12 education?   Yes No
    If yes, please describe:
 
Applicant Licensure
 
Current License: Provisional
Conditional
Professional
Accomplished
 
Subject Area Endorsements: Biology
Chemistry
Earth & Space Science
Mathematics
Physics
Science
Other:  
 
Years Teaching:
(numerical response only):
Years Teaching Science or Mathematics:
(numerical response only)
Scientific Research Experience
 
Explain your personal experiences with scientific research.
 
Check all the following practices that you use in leading classroom inquiry instruction:
Classroom Demonstration
Mini-labs
Field Activities
District Workshops
University Workshops
Hands on Inquiry Activities
Internet Science Modules
Computer Simulations
Kit Based Experiments
Other:  
 
Why have you choosen to apply to the MSSA Research Experiences?
Comments and Questions:
Applicant Perspective
 
Your responses in this section will not effect your MSSA Research Experience Registration. Your responses will guide development of future professional development opportunities.
 
Please rank-order (from 1 to 8) your reasons for applying to the Middle School Science Academy Research Experience. A “1” indicates the item was the strongest motivator for submitting your registration, while an “8” indicates the weakest motivator.
 
Obtain Stipend
Graduate Credit
Improve instructional skills
Improve scientific content knowledge
Staff or organizational reputation
Convenient location (KU Lawrence Campus)
Collaboration with other teachers
Flexible time commitment and summer hours
Registration Submission
 
Check all previously attended MSSA sessions:
Summer 2005 Summer 2006 Summer 2007
Summer 2008 Summer 2009

The following statement must be acknowledged by checking the box in order to process your registration.

I acknowledge and release this and any other information collected by MSSA to be used for educational research purposes by the University of Kansas. I understand that no personally identifiable information will be released and only aggregated data will be published.