ACTIVATE 2012
Advancing Computing and Technology Interest and innoVAtion through Teacher Education

Application Form - deadline: June 7, 2012

Seating is limited and applications will be reviewed on a first come, first served basis. Since these workshops are part of an NSF research study aimed at high school teachers, you must teach some students in grades 9, 10, 11 or 12 to be eligible. Applications cannot be fully reviewed until all required documentation is received. Each workshop is open to new participants only; if you did not attend one of the ACTIVATE workshops previously, you may register for that workshop.

Participants will be asked to complete various surveys during and after the workshops as part of an NSF research study. 

PERSONAL INFORMATION

Name:

Home Address:

Name of school:

School address:

Contact phone number:

Email address:

Subject(s) taught:

Grade(s) taught:

Years teaching:

Race*: 

*NOTE: This information is required by our Institutional Review Board since this is an NSF research study involving human subjects.

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WORKSHOP INFORMATION

Which workshops are you are interested in? 
(Check or circle each workshop that you wish to attend.)

	Computing with Alice (July 9-13, 2012)

	Computational Thinking with Python (July 16-20, 2012)

	JAVA Programming for Math & Science  (July 23-27, 2012)

Do you need on-campus housing for any workshop? If so, please specify dates.**

**Housing note: If needed, accepted participants will be eligible for free on-campus housing for 5 nights for the workshop that they participate in, starting with the night before the first day of the workshop. (Participants are expected to check out on the last day of the workshop.) Participants may be able to stay additional nights on-campus between workshops if necessary but would be responsible for their own costs. Please inquire for more information.

How would you travel to Carnegie Mellon (car, train, plane, bus):

Do you have any special needs that we can address for you while on campus (e.g. disabilities or dietary restrictions)? If so, please specify:

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ADDITIONAL INFORMATION

If you attend, do you need a certificate in order to receive professional development credits for participating in your workshop(s)? (yes or no)

Explain in one paragraph why you want to attend the workshop(s) :

Please email, fax or send your hard copy application and your letter of support 
no later than June 7, 2012 to:

Ms Barbara Grandillo
Re: ACTIVATE 2012
Computer Science Department
Carnegie Mellon University
5000 Forbes Avenue
Pittsburgh, PA 15213

Email: bag+@cs.cmu.edu
Phone: 412-268-7550
Fax: 412-268-5576