Part 1:

Last Name: First Name:

Home Address:

School Name:

School Address:

Email Addresses:

Phone Numbers:

Grade Level Taught:
Years Experience:

Subjects Taught in Last 2 Years:

If you have any formal training in materials science or engineering, please briefly describe:

If you have any industrial experience, please briefly describe:

Do you have access to a microscope?
Yes No

What other teacher training programs have you attended in the past five year? Please list the name, location, and length of program:

Please List your academic degree(s) (degree, major, and minor (if applicable):

Part 2:

Please write a 100 word essay on why you would like to attend this Camp and what your expectatioins are.

Please note: Last year we had many more applicants than spaces available. If there is an excess of applicants and you cannot attend the Rutgers Camp, would you be interested in attending the Camp at Princeton University (August 6-10)?
Yes No