Application to Participate in the 2012-2013 Limited Rollout

Thank you for your interest in teaching Engineer Your World, the high school engineering design and problem solving course of UTeachEngineering at The University of Texas at Austin.

You are applying to join the 2012-2013 limited rollout of Engineer Your World and to participate in a two-week professional development workshop at The University of Texas at Austin’s Pickle Research Campus that will prepare you to teach the course. For general information about the limited rollout, visit the Learn More page.

During the professional development workshop you should expect to spend 40 hours per week engaged in active class and lab work, and additional hours completing out-of-class readings and projects. You may also be required to complete up to 20 hours of preparatory work prior to attending the workshop. Additional requirements will be detailed in a participant agreement that you will receive upon acceptance into the program.

Participants will receive, upon successful completion of the summer professional development program, a $1000 stipend and access to the Engineer Your World course curriculum. Housing is provided and airfare or mileage is reimbursed for participants who do not reside in the Central Texas area.

Participants will be required to provide feedback during implementation on the Engineer Your World course materials (teachers will receive a stipend for their feedback during the academic year. Please provide all of the requested information in this online application form below. Upon submission of your completed online application, you will receive an email containing additional information. Questions may be emailed to Theresa Dobbs.

Application to Participate in the 2012-2013 Limited Rollout

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Summer Profesional Development Dates for 2012

Is your school located in Texas?*

Yes No

Select the Session Date*:

Do you have a conflict with your session date? Please explain:

Would you like information about a Weighted/Honors version of the course based on the current draft of AP® standards for engineering?*

Yes No

* Indicates a required field

Applicant General Information

First Name*:
Last Name*:
Home Mailing Address*:
City*:
State*:
Zip code*:
Home or Cell Phone*:
Email*:
Current Title or Position*:
What subject(s) do you teach?*
What grade(s) do you teach?*
What other subject(s) have you taught?*
Teaching Experience (Years)*:
Teaching Certification(s)*:		(Please list all)
Certification Route*:
Please indicate your gender*:		Male Female
To the extent provided by applicable law, no person shall be excluded from participation in, denied the benefits of, or be subject to discrimination under, any program or activity sponsored or conducted by The University of Texas System or any of its institutions, on the basis of race, color, national origin, religion, sex, age, veteran status, or disability. So that we may track demographic data, please select your ethnicity from the following list*:

* Indicates a required field

Applicant's School Information

Full School Name*:
School District*:
City*:
State*:
Principal's Name*:
Principal's Phone*:
Principal's Email*:
School Classification*:
Is this a Title I School?*

* Indicates a required field

School District Contact Information

Who is the district point of contact for legal participation agreements?

Name*:
Title*:
Phone*:
Email*:

Who is the district point of contact for research and evaluation agreements?

Name*:
Title*:
Phone*:
Email*:

* Indicates a required field

Applicant Educational Background

College / University Degree(s)
Degree *	College / University *	Year *	Major *	Minor *

* Indicates a required field

Have you taken any Engineering courses?*

Yes No

If yes, please list them:

Have you attended previous teacher professional development for engineering education (e.g. PLTW training, Infinity Project training, Boston Museum of Science)?*.

Yes No

If yes, please list which ones:

Do you have previous engineering or design work experience?*:

Yes No

If yes, please describe:

Please acknowledge each statement below by checking the corresponding box:

	I intend to implement the EYW curriculum during the 2012-2013 school year*
	I agree to attend a summer professional development session*
	My campus administration supports my participation in this effort*
	I understand my campus will need to procure the equipment and materials needed for the course*
	I understand I may need to complete up to 20 hours of pre-work prior to attending the professional development program*
	I agree to provide feedback as requested during implementation (details to be provided in the teacher participation agreement)*

<==All information on this application is complete and correct.*

Please verify that you have completed all required fields before submitting your application.