Astrobiology Laboratory Institute for Instructor (ALI'I)
Deadline - March 31, 2013

All information is needed!
Name(Last, First):
Home Address:
School Name:
School Address:
School Phone:
School Fax:
Years of Teaching:
# of Schools taught at:
Major(s) and Degree(s):
Science courses you have taught:
Course you will be teaching:
Grade level(s) you teach:
Why are you interested in attending this astrobiology workshop?
Into what course(s) you teach, are you planning to include astrobiology topics or, for returnees, have already implemented astrobiology activities?:
What do you hope to gain from participating in this program:
Are you willing to conduct secondary teacher workshops in the following school year? Describe your experience in conducting workshops.
Would you be willing to do some background reading prior to attending this workshop? Yes No
Will you implement workshop materials in your classes? Yes No
Are you applying for the University of Hawaii graduate credit for coursework? Yes No
I wish to be subsidized for airfare, housing and meals (for Hawaii teachers only, except Oahu)? Yes No
I wish to be subsidized for my airfare, housing and meals expenses (for continental US teachers only)? Yes No

Before you hit the button, please double check!