Illinois EarthScope Workshop for Middle and High School Science Teachers
2012 Application
(You may copy this application)

Application Deadline February 29, 2012

Last Name:                                          First Name:

Home Address:


Cell Phone:                                          Home Phone:

Primary Email:                                    Secondary Email:

School:                                                School Phone:
School Address:



Grade:                                                  Subjects Taught:
                                                             Class sizes:

Previous inservice workshops



Undergraduate Degree (Major and Date):

Graduate Program(s)

Will you need on campus housing?                  You will share a room unless proven medical need

Any food concerns?

Any special needs or concerns?

Please answer the following questions

Why do you want to attend a workshop on the geology of the midcontinent (with emphasis on Illinois and the New Madrid Earthquakes), plate tectonics, earthquakes, volcanoes, and an opportunity to be involved in a REALLY BIG SCIENCE research project?


What are your future plans for teaching Earth Science, Geology or integration workshop materials into your class?




Email this Application form as an attachment to 
use the subject EarthScope 2012 Workshop