Cohort 2 Application and Registration

To apply for the Professional Development for Advanced Coursework in STEM, please complete the three sections below.

Application
How did you hear about the STEM PD Program?
Kindle Fire™ Referral Friend

Did another NYSTEM attendee refer you to this program? Enter their name and you will both be automatically entered into a drawing to win a Kindle Fire™ for each of you.
Friend's Full Name

First NameLast Name
Principal or Administrator Referral

Provide accurate contact information so we can work with your principal or administrator to assist you to attend training during the school year.
Please enter the name of the principal or administrator that referred you to this application:
Please enter the email address of the principal or administrator that referred you to this application:
Please enter the name of your superintendent:
Applicant Information
First Name
Last Name
Teacher ID Number Creation
Your self-created teacher ID is used to identify you throughout the program. It is made of the last 4 digits of your home phone number (or cell phone if you do not have a home phone), your birth month, and your birthdate.

EXAMPLE: 5555-MM-DD

EXAMPLE: John Smith, born March 15th, at 212-555-5555

Teacher ID: 5555-03-15
LAST 4 digits of HOME phone number (use cell number if you do not have a home phone)
Birth Month (e.g. if you were born in March select 03)
Birthdate (e.g 15th)
Teacher Contact Information
Work Email
Personal Email You will receive your application confirmation at this address
Enter an e-mail you access even during vacation and summer months
Work Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Do you give us permission to send text message reminders/updates to your cell phone? (Mobile phone text messaging charges may apply. Please consult your mobile phone service plan.)
School District Name
County of School District
Region (choose)
School Name
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Education/Background
Select Your Highest Level Of Education
If other please explain:
Grade Level(s) You Teach (check all that apply)
Teaching Experience
How many years of teaching experience do you have?

Please indicate the STEM subjects that are taught in your school and whether or not you teach them. Please check all boxes that apply

Rows	This subject is offered as Advanced Placement in my school	I teach this subject as Advanced Placement in my school	I teach this subject but NOT as Advanced Placement in my school
Mathematics Courses
Science Courses
Technology
Engineering
Library Science
Other

If "Other," Please Specify
Please continue on to the Workshop Site Selection portion of the application

Workshop Site Selection
The five-day Institutes in Strategies for Vertical Teams will focus on aligned curriculum through vertical teaming in mathematics or science. All the workshops are FREE, and participation will enhance your knowledge, skills, and ability to prepare your students for the Common Core Standards and for college and careers.

Professional development workshops are offered at locations throughout New York City and Long Island (you will be able to change your site for future sessions). There will also be two separate sets of dates when you can choose to attend the sessions.

Below, please select the dates that you would like to attend the PD and whether you would like to take the PD in either NYC or Long Island.

Information will be e-mailed to you about the site location as it becomes available.
Please select a date
Please select a site
Please select your session:
Select the session that most closely aligns with the subjects you teach. If you teach a subject other than math or science, we recommend selecting "Vertical Teaming in Science."
Thank you. Please continue below.

____________________________________________________________________________________________________________
By completing this application the participant agrees to the terms outlined below:

The NYSED STEM Teacher instructs secondary STEM subjects, and will agree to participate in the multi-year training (through summer of 2014) including:

-Register and participate in a total of 70 hours of Professional Development during the course of the NYSTEM program, with the support of the principal and district leadership.

-Implement the strategies learned throughout the training in their classroom, and engage colleagues in strategies learned throughout the training.

-Complete an online workshop evaluation form for each PD activity to receive a certificate and CEUs.

-After receiving training in year one, promote and participate in school-based AP Vertical Teams.

-Apply STEM strategies when teaching and share best practices with school staff.
Questions/comments/problems?
Should be Empty:

Application

Kindle Fire™ Referral Friend

Principal or Administrator Referral

Applicant Information

Teacher ID Number Creation

Teacher Contact Information

Education/Background

Teaching Experience

Workshop Site Selection

Thank you. Please continue below.