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CSUDH Math Teacher Circle Summer 2019 Application
Please complete the following application if you wish to attend the two-day workshop to be held at CSUDH June 20-21, 8:30 am - 4:00 pm.
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* Indicates required question
First name:
*
Your answer
Last name:
*
Your answer
Contact Information (we need to be able to reach you during summer):
contact email:
*
Your answer
phone number (no parentheses or hyphens):
*
Your answer
Background information (for purposes of reporting to funding agencies):
Your school:
Your answer
How many years have you been a K-12 teacher?
Choose
1
2
3
4
5
6
7
8
9
10
11-15
16-20
21-25
26-30
31 or more
What was your college major?
Your answer
Is your credential Clear or Preliminary?
Clear
Preliminary
Clear selection
Do you have a Supplemental or Subject Authorization for Mathematics?
No
Yes
Clear selection
What kind of teaching credential(s) do you have (choose all that apply)?
Multiple subject credential
Single Subject credential in Mathematics
Other:
What is your gender?
Male
Female
Clear selection
What is your ethnicity? (Please select all that apply.)
American Indian or Alaskan Native
Asian or Pacific Islander
Black or African American
Hispanic or Latina/o
White or Caucasian
Prefer not to answer
What grade level(s) are you teaching this year? (List them.)
Your answer
What do you hope to gain by attending the summer Math Teacher Circle? Please answer in a couple of sentences.
Your answer
Thank you. Decisions will be made by May 20.
If you have any questions, please call or email Sheila Wood, 310-243-2203, or
swood@csudh.edu
.
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