Advancing Science Annual Member Profile
This form is required once per academic year - please wait to complete the form until you know your class roster and schedule.
Full Name
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First Name
Last Name
Email Address
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example@example.com
School Information
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Building Name
District Name
Course 1 Details
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Rows
Your Response
For grades K-8, list the grade level. For High School, list the course name.
Total Number of Classes
Total Number of Students
Number of Students in Your Largest Class
Class Schedule (for example: 8:00-8:50, 8:55-9:45) if you plan to request visits
For High School Only, is this a SEMESTER or FULL-YEAR course?
For High School Only, how many classes are accelerated, advanced, or AP?
For High School Only, how many students are accelerated, advanced, or AP?
Do you need to share information for another course?
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Yes
No
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Course 2 Details
Rows
Your Response
Course 2 Name - For grades K-8, list your grade level. For High School, list the course name.
Total Number of Classes
Total Number of Students
Number of Students in Your Largest Class
Class Schedule (for example: 8:00-8:50, 8:55-9:45) if you plan to request visits
For High School Only, is this a SEMESTER or FULL-YEAR course?
For High School Only, how many classes are accelerated, advanced, or AP?
For High School Only, how many students are accelerated, advanced, or AP?
Course 3 Details
Rows
Your Response
Course 3 Name - For grades K-8, list your grade level. For High School, list the course name.
Total Number of Classes
Total Number of Students
Number of Students in Your Largest Class
Class Schedule (for example: 8:00-8:50, 8:55-9:45) if you plan to request visits
For High School Only, is this a SEMESTER or FULL-YEAR course?
For High School Only, how many classes are accelerated, advanced, or AP?
For High School Only, how many students are accelerated, advanced, or AP?
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Next
Please review Advancing Science's policies and procedures:
I. The Teacher is an Active Partner. The classroom teacher must be an active classroom partner during Advancing Science visits. We know our equipment, and you know your students; together we make a great team. Throughout the activity, please (a) manage student behavior, (b) connect the lab activity to classroom learning, and(c) remain engaged with the students throughout the visit.
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I agree.
II. The member teacher's presence is required during the use of Advancing Science resources. Advancing Science resources may NOT be used by substitute teachers or others who have not attended an Advancing Science training event. If you will be absent during a visit, it must be rescheduled or covered by another Advancing Science member teacher. Loaned resources may only be used under the supervision of an Advancing Science member teacher; do not leave substitute teacher plans that involve the use of Advancing Science materials.
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I agree
III. Lab Safety. Teachers will make their best effort to ensure safety during lab activities. The science classroom must include the safety resources necessary for the safe operation of the requested resource kit. Safety requirements include, but are not limited to: safety goggles, eyewash station, handwashing protocols, fire suppression, and other best practices recommended by science education professional organizations (e.g., National Science Teachers Association, American Chemical Society)
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I agree
IV. Submitting Requests. Visit and loan requests must be submitted via the Advancing Science web form at least two weeks in advance. For the best availability of equipment and staff, more notice is strongly recommended.
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I agree
V. Responsible Use. Teachers agree to request loans only if they have time to use the equipment. Unused loans waste time, resources, and may impact another teacher who is interested in the same materials at the same time. Please email the Advancing Science staff as soon as possible if you need to reschedule or cancel a resource kit loan.
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I agree
VI. Service Limits. Teacher interest in our program has increased, but our funding has remained flat. To serve as many teachers as possible, it is necessary to enact the following limits. Teachers may request a maximum of 3 visits per year. At this point, we do not anticipate a need to limit the number of loans. Advancing Science reserves the right to adjust these limits based on request volume and staff/equipment availability.
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I agree
VII. Teachers agree to participate in evaluations and surveys when requested by Advancing Science. The results are used to report to funding organizations, solicit future funds, and guide future programming
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I agree
Submit
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