2024 Teacher Application Form

2025 Teacher Application Form

Green and Sustainable Chemistry Workshop | June 16-18, 2025
Name*

First NameLast Name
School District*
School Name*
Personal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Preferred email address during summer (if different than above)
example@example.com
Phone Number*

Area CodePhone Number
Best way to contact you:*

EmailPhone

How familiar are you with Green Chemistry concepts?*

	1	2	3	4	5

1 is Not At All, 5 is Very

Are you currently incorporating principles of Green Chemistry in your instruction?*

	1	2	3	4	5

1 is Never, 5 is Often

Why are you interested in attending this workshop?*
Are you planning to attend the workshop as a school team?*
Preference may be given to those attending as a team of teachers from the same school/district.
Would you be interested in pursuing graduate credits (2.0) for a cost to you of approximately $105.00?*

YesNo
Would you require residence hall accommodations for three nights (single occupancy shared bathrooms)?*

YesNo
Do you require a parking permit (for residence hall guests only)?

NoYes - overnightYes - daily
How did you learn about the workshop?

Former participantMnSTA NewsletterMnCOSE ConferenceMRSEC websiteOther
To which gender identity do you most identify

MaleFemaleNon-binary
I am willing to share a BATHROOM with people who, in the previous question, selected:

MaleFemaleNon-binary
Please share any additional comments here
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2025 Teacher Application Form