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Schulze Summer STEM Institute for Teachers Application Form

Unique Identification

Please create a unique identification code. Your information will be tracked using this identifier. You will be asked to enter this same code on future STEM Institute documents.

1. What is the first letter of your mother’s first name? Example: If your mother's name is Alice Smith, the unique letter would be A.*

2. List the two numbers representing the month in which you were born (e.g., May= 05).*

3. What is the first initial of your mother’s maiden name? For example, if your mother's name is Alice Smith, the unique letter would be S.*

Sample code from the examples above: A05S

Personal Contact Information

Name*

First Name*

Last Name*

Home Phone*

Email Address*

Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Gender

Female Male Prefer to self-describe: Prefer not to answer

How did you hear about the STEM Institute

Website Flyer Referred by colleague Through FGCU Faculty Through the Conservancy

Other: Other Value

Have you attended the STEM Institute in the past?*

Yes No

Please note that because of the funding availability we may not be able to accept applicants who attended the STEM Institute in the last two years.

School Name*

School Address*

Address Line 1

Address Line 2

City

State

ZIP Code

County/District*

School Phone*

Schulze Summer STEM Institute for Teachers Online Application Form

Please indicate which session you are available to attend. *

June 24-28 July 15-19 EITHER

Teaching Experience

Number of years teaching*

Grade level(s) taught*

Lower Elementary (K-2) Upper Elementary (3-5) Middle School (6-8) High School (9-12) All Grades

Other: Other Value

Subject(s) taught*

Title 1 school?

Yes No

Please answer the following prompts in the boxes provided below in 150 words or less.

How would you describe your efficacy in teaching STEM subjects? (STEM teaching efficacy is a teacher's belief in their own ability to guide their students to success in STEM subjects.)*

What do you hope to gain from this summer's STEM Institute?*

How do you intend to share the information and skills attained at the Summer STEM Institute inside of your classroom? (i.e. with your students)*

How do you intend to share the information and skills attained at the Summer STEM Institute with your colleagues, principal, district, or others?*

Additional information to be considered: (Ex. special accommodations, dietary requirements, applying with another teacher from your school-please list, etc.)

Master In-service points (MIP’s) and Professional Development points may be available through your district and/or school. Please contact them directly for more information.

STEM Institute Agreement

Upon acceptance to the STEM Institute, you agree to complete the following activities to receive a classroom grant in the amount of $1000 for STEM classroom supplies or field trips. Failure to attend all of the activities may result in a reduction (or elimination) of the classroom funds available to you.
You agree to

Attend each session during the five days of the STEM Institute.
Complete all surveys requested regarding the STEM Institute and your implementation of STEM practices in your classroom.
Develop an inquiry-based STEM Lesson Plan based on the 5E model template provided during the workshop to be submitted by Jan. 2025. This may be a collaborative effort by a STEM Institute teacher group.
Provide constructive feedback for improvement on other teachers' lesson plans.
Provide photos and/or videos of you using the STEM supplies purchased with the $1000 classroom grant to be shared with donors.

I agree I do not agree