*I will be attending the:

5 day Institute with guided curriculum development – July 19-23

3 day foundation course – July 19-21

For 5 day participants contributing to the MA EfS Pilot:

I am interested in learning about:

Scholarship (waived tuition available) for public school educators serving high needs districts who commit to:
1) creating a minimum of two lesson plans for the MA EfS Curriculum Pilot;
2) implementing lesson plans by end of February 2011;
3) attending implementation check-in meeting in April 2011.

*First Name:

*Last Name:

*School Name:

*School Address:

*School Type:

Public Private Home School Pre-Service Substitute

District:

County:

City:

State:

Zip:

School Phone:

School Fax:

*E-mail:

Grade Level(s) I teach:

Subjects I teach:

Home Address:

City:

State:

Zip:

Home Phone:

Home Fax:

Home E-mail:

Mail information to:

School Home

Call at:

School Home

E-mail me at:

School Home

* I will apply for: