EXES Teacher Program
The University of Texas at Austin

PERSONAL INFORMATION:

Name ____________________________________________

School ___________________________________________

School Address ____________________________________

City, State, Zip ____________________________________

School telephone number (___) _________ School FAX (___) __________

Electronic mail address _______________________________________

Subject(s) and grade(s) taught _______________________

Years experience _______

Teaching certification areas: ___________________________________________

Home address ___________________________ One way mileage from home ______

City, State, Zip __________________________

Home telephone number (____) ___________ SS number (optional) _____________

What is the best way to reach you during the day? ___________________

COLLEGE/UNIVERSITY EDUCATION:

Undergraduate Institution _______________ City, State ___________________

Major(s)____________ Minor(s)________________ Degree & year ___________

Graduate Institution(s)________________ City, State ____________________

Degree(s)_____________________ Major ___________________ Year _______

PROFESSIONAL ACTIVITIES:

1. In which organizations do you hold memberships? AAPT ____ ASP ____

NESTA ____ NSTA ____ TESTA ____ Others __________________________

2. Do you hold, or have you held, leadership positions in any science education or science organizations? If so list them here:

3. Which of the following science periodicals do you read regularly?

Astronomy __ Mercury ___ Scientific American ___ StarDate _____

Sky & Telescope ___ Others ________________________________

4. List all science or science education institutes of five days or more which you have attended within the past five years. (Indicate name, subject matter, length of institute, and the funding source, e.g. NASA, NSF, Eisenhower, other).

5. Give a brief summary of your experience of presenting papers at science education meetings, conducting teacher workshops, or making presentations to civic organizations within the last five years. (For each, list date, location, and organization.)

ADDITIONAL INFORMATION REQUESTED:

1. Attach an essay (100 words maximum) on your personal philosophy of science teaching and how you will disseminate information on SOFIA and the EXES project within your community (beyond your individual classroom).

2. Obtain one letter of recommendation from your department head, principal, science coordinator, and/or superintendent. The letter may be mailed, faxed, or e-mailed separately.

WHERE TO SUBMIT APPLICATION:

Applications may be e-mailed to marykay@astro.as.utexas.edu, faxed to 512-471-6016 (attn.: Dr. Hemenway), or mailed to:

Dr. Mary Kay Hemenway
Astronomy Department
University of Texas at Austin
Austin, TX 78712-1083