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APPLICATION to reserve a seat (noncredit) in ASU course in summer 2015 – NON-RESIDENTS

April 28, 2015

Out-of-state (non-resident) high school science or math teacher:

Since you'd like to take a Modeling Workshop offered by ASU in summer 2015, please fill out this form.

The ASU Dept of Physics asks that teachers pay tuition if possible (rather than take the course for re-certification credit), since the state gives ASU much less now. ASU graduate non-resident tuition & fees in summer 2015 are about $3250 for a 3-semester-hour course. Audit is the same cost. Call me for suggestions to make this affordable. For ASU credit: Apply online to ASU and pay the $70 application fee by May 12 to avoid a $50 late fee. Instructions at ; click on “ASU logistics & the application process”.

a) The ASU Dept. of Physics allows up to 20% of participants to be non-credit if space is available. Apply below; preference to leaders. You need NOT apply to ASU. Registration fee is $200. Ask Jane Jackson how to pay.

b) We can help arrange low-cost apartment housing on campus (private bedroom) & family housing. Tell me now!

* Consider earning our MNS degree. Financial aid is available; see

* Please give the Simplified Force Concept Inventory (or appropriate concept inventory for your subject) to your students this spring, and next year as a pretest & posttest. Download it at

* Ask local service organizations (Rotary, etc.) for financial support: see

or download in MS-Word at

Sincerely, Jane Jackson , Co-Director, Modeling Instruction Program, ASU.

(You can omit the underlines: they are just space-holders.)

YOUR NAME (printed): _________________________________________Date: ________

E-MAIL: ______________________________ ___________________________________

HOME e-mail SCHOOL e-mail

Your preferred e-mail address in summer: _________________________

home address: street:_____________________ city: ____________________zip code: ______

home phone: ______________ cell phone: _____________ school phone: ______________

your school: _________________________________ school district: __________________

subjects that you’ll teach next year:____________________________ grade(s): __________

content area of your bachelor’s degree: _____________________ # years you’ve taught: ___

your principal’s name (or API): __________________________his phone: _______________

principal’s email address (or API): ________________________ Is your school Title I? ___

Which course(s) do you want? (Highlight it or delete others. Visit our web page for description, prereqs.)

June 8-26: PHS 530: Methods of Teaching Physics I (Modl Wrkshp/mechanics. Edelbrock, 8-3:30MTWTh. 8-12F)

June 8-26: PHS 594: Modeling Instruction in Mechanical Waves & Sound (Michael Crofton, 8-3:30. 8-12F)

June 15-26: CHM 594: Modeling Instruction in HS Chemistry II (Phil Root, 8-3:30MTWTh. 8-12F)

July 6-24: CHM 594: Modeling Instruct in HS Chemistry I (Russ Shaffer, 8-3:30. 8-12F. Carl Hayden HS, Phx)

June 29-July 31: PHS 581/CHM 581: Structure of Matter (Bob Culbertson, 11:10-2:00pm MTWTh at ASU)

June 29-July 31: PHS 550: Physics and Astronomy (Carl Covatto, 3:40-6:30pm MTWTh at ASU-Tempe)

Alternate Fridays June 12-July 24, 1:10pm: PHS 598: Leadership Workshop. Jim Archambault. No scholarships. (Jim can make arrangements for distance learning in June, if you cannot be here then.)

Have you already applied to ASU? ___ Have you already registered for this course? _____

a) Do you want me to help arrange low-cost on-campus apartment (private bdrm) housing for you? _____

b) Do you want to reserve a seat for non-credit? ______ If so, please tell us about your commitment to future leadership in effective science instruction, and how you can lead.

c) Do you want to apply for a partial tuition scholarship (maximum $1250)? If so, describe your commitment to future leadership in effective science instruction, and how you can lead.

Do you have an advanced degree (Masters? Doctorate?) _____ What subject? ___________

Have you ever attended ASU? ____ If so, in what year? _______

Year you were born: _____

Are you enrolled in an ASU degree program? ____ If so, which one? __________________

Are you taking any ASU course in spring 2015 semester? _____ If so, what course? __________

If you attended ASU, you have a 10-digit ASU ID number. Type it if you know it. __________

Please e-mail, mail, or fax this application to: jane.jackson@asu.edu Fax: 480-965-7565

Modeling Instruction Program, Box 871504, Dept. of Physics, ASU, Tempe AZ 85287.

Questions? call Jane Jackson: 480-314-1522 at home (any time); 480-965-8438 Keep in touch!

Visit and click on "ASU Graduate Program for High School Teachers of the Physical Sciences", for course info, descriptions, prerequisites; instructions on applying to ASU. (For ASU credit, apply to ASU & pay $70 appl fee by May 12 to avoid $50 late fee. DON’T register for a course until May 19 or later; but DO register very soon after May 19. Call Jane Jackson if this is confusing.)

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