COSEE SE Ocean Sciences Education Leadership Institute
Pine Knoll Shores, NC
July 23 – July 28, 2006

APPLICATION

This form, received by April 1, 2006, constitutes formal application to the COSEE SE Ocean Sciences Education Leadership Institute. Please print out form and type or print clearly. Late applications will be considered only if institute vacancies exist. This form may be duplicated.

RETURN THIS FORM TO:
Margaret M. Olsen
COSEE SE Education Specialist
30 Ocean Science Circle
Savannah, GA 31411
FAX: 912-598-2302
E: olsen@uga.edu

Mr./Mrs./Ms./Dr.: Name: __________________________________________

Home Address: _________________________________________________

City, State Zip: __________________________________________________

Home Phone: _____________________ Cell Phone: ___________________

Preferred Email (please print clearly) ________________________________

Work Place and Address: _________________________________________

Name of Principal or Supervisor: ____________________________________

Work Address: __________________________________________________

City, State, Zip: _________________________________________________

Work Phone: ___________________          FAX: ______________________

Position:  ______________________________________________________

Subject(s) taught: _______________________________________________

Years Teaching: _____________ Grade Level: ______________

• What instructional experience do you have teaching marine/ocean concepts?

• Explain why you would like to participate in this Institute and how you would use it in your classroom:

• List any other similar workshops (if any) that you have attended in the last three years.

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Completion of this application requires your principal or supervisor’s signature below:
I recommend the above person for participation in the COSEE SE Ocean Sciences Education Leadership Institute. I will encourage and support the post-Institute criteria to promote marine science in the community and the classroom.

____________________________________________                Date:_______________________
(Principal or Supervisor Signature

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