ResearchExperiencesforTeachersin

Engineering Design and Manufacturing

High School Teacher ApplicationForm

PartA:ApplicantInformation

Name

(Last)(First)(M.)

ContactInformation:

HomeAddressCity

State/ZipCell ()Other (Work/home)()

Email (primary)Email (secondary)

Ifaccepted,Iwill needassistancein reservingsummerhousinginBeaumont, Texas.YesNo

* The accepted teachers will receive stipends ($1,000/week for a regular teacher and $1,200/week for the master teacher) from the program.The teachers will then be responsible for the cost of living.

PartB: EducationandProfessionalDevelopment

Listallcollegedegreesearnedor inprogress:

InstitutionName / Degree / YearEarned / Major/Minor Subject

Listprofessional development activities relatedto STEMeducationinwhichyouhave participatedduring the past five years:Provideabriefexplanation(2-3sentences) regardingwhat you learned/gainedfromeachactivity. :

1)

2)

3)

4)

5)

PartC: School/DistrictInformation

School ContactInformation:

DistrictNameSchool Name

School AddressCity

State/Zip

Phone()

Provideyourcurrent studentcampus(notdistrict)demographics(percentages):

%White%Black%Hispanic%American Indian%Asian

Whatpercentageofyourschool’sstudentsareon thefree lunchprogram? %

PartD: Experience

Whatsubject(s)areyoucertifiedtoteachinTexas?

Whatlaboratoryresearchexperiencehaveyouhad?

Haveyouparticipated inaresearchprogrambefore?Ifso,pleasedescribe thenameof the program,the areaofresearch,andhowlongwas theresearchexperience.

Pleasedescribeyourpriorexperienceincurriculumdevelopment, includinganygroupleadershipexperience

(attach additionalpagesifneeded).

Teachingexperiencehistory(pleasebeginwith themost currentyear):

Nameof School campus / Nameof School District
(andstate,ifoutside TX) / Academic YearsTaught atthat campus / Subject(s) Taught
Example: XYZHighSchool / Example:
ABCSchoolDistrict / Example:
2009-present / Example: AlgebraI, Geometry

PartE:Essays

1. (Requiredforallapplicants)Pleasewrite andattacha1-2pageessaythataddresseseachofthe followingtopics.Providespecific exampleswhereverpossible.

Whydoyouwantto participate inthis program?

Whatdoyouhopetogain?

Describeprofessional leadership rolesyouhaveheld.

How wouldyouexpecttotakethisexperienceback tofacultyandstudentsatyourcampus?

2. (Requiredonlyforapplicantswhowishtobeconsidered for theMasterTeacherposition)The roleof theMaster Teacherpositionis toprovideadditionalassistanceduring thecurriculum developmentprocesstoother teacherparticipantsin thecohort.TheMasterTeacher shouldhave curriculum development andadministrativeexperience.TheMaster Teacherneedstobepositive and approachableandhavestrongcommunication skills. TheMasterTeacher mustbeableto provide curriculum assistance toteachers who teachsubjectsotherthanthose ofthe MasterTeacher.TheMaster Teacher mustbeagoodproblemsolver,andalsohave the abilitytoprovide timelysupportto participants.Pleasewrite andattacha1-pageessaythataddresswhatyou thinkarethebiggest challengesthatteacherswill face during the programandwhatyou,astheMaster Teacher,coulddo to help theteachers. Pleasegiveconcreteexamplesofwhatyouwoulddo.

PartF: Sample LessonPlan

Pleaseattachoneofyourcurrent(or previous)lessonplansthat illustrateanon-lecture-stylelesson. For example,youcouldincludealessonthatis interactive,hands-on,cooperative,inquiry-based,or team-oriented.

Part G: Reference

Provideacompletedreferenceformfromyourdepartmentheadoryour campusprincipal/associate principal. Theformcanbeaccessedat

PartH: School PrincipalCertification

ThissectionistobecompletedbythePrincipal or AssistantPrincipalofthe applicant’scampus.

I herebycertifythat

(PrincipalName)(ApplicantName)

isasecondaryteacherinthe School District.

(District Name)

PrincipalSignature:

Date:

Part I:ApplicantCertification

I herebycertifythattheinformationprovidedin this applicationis

(ApplicantName)

correcttothebest of myknowledge:

ApplicantSignature:

Date:

Tobeconsideredforthis program,yourcompletedapplicationpackageshouldbepostmarkedby

March3,2017andinclude:

Completeapplicationwith signaturesfrom:

oPrincipal orAssistant Principal

oApplicant

Essay(s)–All applicants mustsubmitanessayforPartE(1)above. In addition,applicantswho

wish to beconsideredfortheMaster Teacherposition must submitanessayforPartE(2).We anticipatethateachsummer cohortwill consistoffive Teacher participants andoneMaster Teacher

participant.

Samplelessonplan

RecommendationformfromyourPrincipal orAssistant Principal (enclosed inasealedenvelope)

Submitall applicationmaterialstogetherinoneenvelopeandsendviaU.S.postalmail to: Dr.Weihang Zhu

ResearchExperiences forTeachersinEngineering Design and Manufacturing

Department of Industrial Engineering, P.O.Box 10032

LamarUniversity

Beaumont,TX 77710

Applicantswill benotified byMarch 24,2017.