NSF GK-12 GLACIER
Teacher Application

Before you apply, please read a letter about the benefits of being a GK12 teacher and also
a document explaining the expectations of teacher partners.
Name: Email address:

Home Address:

City: State: Zip Code:

Home Phone Number:

School:

School Address:

City: State: Zip Code:

School Phone Number: School Fax Number:

I will be able to attend the Summer Workshop held Aug. 1-4 and August 8-11th, 2016 Yes No

Grade levels: (Check all that apply.)

5th

6th

7th

 8th

Please list all subjects which you teach:

Total Years of Teaching Experience (in all schools)

Major in college:

Minor in college:

Highest Degree Earned:
Bachelors
Masters
Ph.D.

Principal: E-mail: Phone:

Professional Reference: E-mail: Phone:

1) Why are you interested in the Project GLACIER?

2) Have you had any experience supervising student teachers/aides
in your classroom? If so, please describe.

Will you be supervising anyone else in your classroom (e.g. student teacher, intern)?
No
Yes. Please decribe in what capacity:

3) What role do you envision for a GLACIER fellow in your classroom?