First Avenue King of Prussia PA fax Arkema Science by bronbron

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									                                900 First Avenue
                                King of Prussia, PA 19406
                                610-878-6439
                                fax 610-878-6261




Arkema Science Teacher
Program Application

August 4 - 7, 2008
Arkema Research Center
King of Prussia, Pennsylvania



Attention: Dana Swan
Arkema Inc.
900 First Avenue
King of Prussia, PA 19406
Fax: 610-878-6261
E-mail: dana.swan@arkema.com




Deadline: March 3, 2008
  2008 Science Teacher Program Application
 To Principal:

 Please complete pages 1 & 2 of application as fully as possible. Have each teacher
 complete the remaining pages. Teachers nominated must be from grades 3, 4,
 5 or 6. Please nominate two teachers.



 School Name: __________________________________________________________

 Principal: ______________________________________________________________

 School Address: ________________________________________________________

 City: ___________________________ State: __________Zip: _____________

 Telephone: ______________________ Fax: _________________________________

 Grades: ________________________ Total School Enrollment: _________________

 I nominate two teachers from grades 3, 4, 5, or 6. Or teacher teams can come from grades
 3 & 4 – or – 5 & 6.)

 Name: _________________________________________ Grade: ____________

 Name: _________________________________________ Grade: ____________




No. ____________

(For internal use only)
Arkema Science Teacher Program                                      Deadline: March 3, 2008
August 4-7, 2008


 To Principal:

In the space provided, please indicate how your school might benefit from
participation in the Arkema Science Teacher Program.

   Is your school committed to greater use of hands-on activities in your science program? Please
   describe existing or planned initiatives.




   Describe the hands-on science kit inventory currently at your school:

       ► Kits:

       ► A few kits:

       ► Several, well-furbished kits:




   How will the recommended teachers provide enthusiastic leadership for science reform at your
   school?




    Please explain how the applicants will share their experiences with fellow teachers:




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Arkema Science Teacher Program                                    Deadline: March 3, 2008
August 4-7, 2008



 Teacher Nominee Section

Instructions: Nominee, please answer the following questions as fully as
possible. Return completed form to your Principal.


Name: __________________________________________                  Grade(s): ______

School: ______________________________________________________________

Home Address: ________________________________________________________

Home Telephone Number: _______________________________________________

Home e-mail: __________________________________________________________

School Telephone Number: _______________________________________________

School e-mail: __________________________________________________________




   Educational Background:



   How long have you been teaching?



   Are you willing to present an in-service program for your school based on your experiences at the
   Arkema program?



   Why do you want to participate in Arkema’s program? (Take as much space as you need.)




                                                                                                  3
Arkema Science Teacher Program                                     Deadline: March 3, 2008
August 4-7, 2008




 Teacher Nominee Section

Instructions: Nominee, please answer the following questions as fully as
possible. Return completed form to your Principal.


Name: __________________________________________                   Grade(s): ______

School: ______________________________________________________________

Home Address: ________________________________________________________

Home Telephone Number: _______________________________________________

Home e-mail: __________________________________________________________

School Telephone Number: _______________________________________________

School e-mail: __________________________________________________________




    Educational Background:



    How long have you been teaching?



    Are you willing to present an in-service program for your school based on your experiences at the
    Arkema program?



Why do you want to participate in Arkema’s program? (Take as much space as you need.)




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