ASM MATERIALS CAMPSM-Teachers Please specify which Teachers Camp (location) you are applying for:   1st Preference:   2nd Preference:

 

Application Form

Part 1

1.       Teachers Name:

2.       Home Address:

(Street or P.O. Box)________________________ (City)________ (State) _____ (Zip)______

3.       School Name:

4.       School Address:

(Street or P.O. Box)_________________________ (City) ________ (State) _____(Zip)______

5.       E-mail Addresses (Home):________________________(School):________________________

6.       Phone Numbers (Home):________________________(School):_________________________

7.       Grade Level Taught:

Number of years teaching experience:

8.       Subjects taught during the past 2 years:

 

 

9.       Have you had any formal training in materials science or engineering?_____Yes _____No

If so, please specify:

 

 

10.    Do you have any industrial experience?_____ Yes _____No

If so, please specify:

 

11.    Do you have access to a microscope?_____ Yes _____No

12.    What other teacher training programs have you attended in the past 5 years?

Training
Location

Length of Training

 

 

 

 



13.    Please list your academic degree/s:

Degrees/Certificates
Years
Major
Minor

 

Part 2

Please write a 100-word essay why you would like to attend this Camp and what your expectations are. (Use a separate sheet of paper and attach to this application form.

RETURN BEFORE 31 March to:

 

Jeane Deatherage

Administrator, Foundation Programs

ASM Materials Education Foundation

Materials Park, OH 44073-0002

Fax: 440/338-4634

E-mail: Jeane.Deatherage@asminternational.org