First Name       Last Name   

 Social Sec. # (needed to award stipend)

email address 

Day Time Phone    Evening Phone

Mailing Address (to send your stipend)

School Name        

School Address

Grade Level Taught:
    Elementary/Pre-school
    Junior High/ Middle School
    High School

How long have you been a teacher?
    Less than 2 years
    2-5 years
    5-10 years
    more than 10 years

Subject Matter Taught:
    Kindergarten
    1st Grade
    2nd Grade
    3rd Grade
    4th Grade
    5th Grade
    6th Grade
    Social Studies
    Science
    English
    Math
    Art
    Music
    Other (Please Specify)

Are you interested in learning more about options to enroll in Colorado State University Summer Programs classes to receive course credit as part of your seminar attendance? Credit would  require enrolling in summer classes, with full tutition and fees and is not included as part of the seminar.
    Yes
    No

Please prepare a summary of how you would be able to use this field collaborative experience in your teaching.  Give specific examples of the classes and students that would be influenced by your participation in this project.  Also discuss way in which you think your skills could contribute to an on-site learning center on the Nebraska High Plains. Remember that although the Hudson-Meng Bonebed is an archaeological site, the building is also the hub of a multi-disciplinary research and environmental education program.