Workshops 2009

Genes to Cognition Online Workshops 2009

1-DAY WORKSHOP FOR BIOLOGY AND PSYCHOLOGY EDUCATORS
Use a multimedia-rich internet site to explore genes, the brain, and cognitive disorders.

Funded by a the William and Flora Hewlett Foundation

Please select a workshop:

November 6, 2009 - Raritan Valley Community College, Somerville, NJ
November 20, 2009 - Great Bay Community College, Portsmouth, NH

This workshop is intended for high school and college science faculty. Selection will be determined using the information supplied by applicants. Selection of workshop participants is competitive and based upon the potential of a participant to apply what has been learned. This will be determined from the information supplied by applicants. A complete application requires one step: to submit the data requested below.

Personal Data

First Name:

Last Name:

Preferred Phone^*:

Preferred Email^*:

^* To contact you with questions and/or notifications.

Home Street Address:

Street Address (cont.):

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Home Email:

Please check your gender:

	Female
	Male

Please check the group that best describes your ethnical/racial status:

	American Indian or Alaskan Native
	Asian or Pacific Islander
	Black, not of Hispanic Origin
	Hispanic or Latino
	White, not of Hispanic Origin
	Do not wish to respond

Please check your age group:

	Under 20
	21-30
	31-40
	41-50
	51-60
	Over 60

Institutional Data

School / Institution / Organization:

School Type:

High School
2-yr. College
4-yr. College

Street Address:

Street Address (cont.):

City:

State:

Zip Code:

Work Phone 1:

Work Phone 2:

Work Fax:

Work Email:

Selection Criterion 1: Professional Qualifications and Teaching Experience

Academic degree(s) and major(s):

Additional training:

Total number of years teaching:

Courses taught in school in the last 5 years:

Selection Criterion 2: Implementation

Describe your interest in attending this workshop:

Describe how you intend to use this training to augment instruction at your school:

Additional Information(Does not affect selection)

How did you find out about this workshop?

DNALC email
DNALC direct mail
On the DNALC Internet site
At a convention or trade show
Link from an Internet site
Internet search
Word of mouth
During a visit to the DNALC in Cold Spring Harbor
Through a local, regional, or national professional organization (such as Bio-Link)
Through a supply or equipment company (such as Carolina Biological Supply Company)
Other (please specify)

I have previously attended a DNALC workshop:

No
Yes (Please specify year and title)

Will you bring a laptop with wireless capabilities to the workshop?

No
Yes

Additional comments