MM-TIP 2003-2004                           

                                                                                                      Preparing Tomorrow's Teachers to Use Technology.

Participant Information

Personal Information:

Last Name:         First Name:    
School/Dept:          SS#:               
County:                 Office Phone: 
Email Address:      Years of Teaching: 
  Population of School (school size):  
  Average class size:

 
Home Address: 
Street:               
City and State:  
Zip Code:         
Home Phone:    

Demographic Information:

Gender:       Male      Female

Your Role in this Grant:     Protégé     Mentor

 Race/Ethnicity:

African American
Asian American
Hispanic
Am. Indian
Caucasian
Pacific Islander
Other
If Other Specify:
Preferred not to answer

 

Educational Background:

B.A./B.S.

          M.A./M.S./MAT/M.Ed.         

Ed.D./Ph.D.


 Computer Use: I have used computers for instruction for the following number of years (not including the 2003-2004 school year):

None
1
2-3
4-5
6-10
over 10 years

 I teach at the following level(s):

Primary Grades (P-2)
Upper Elementary (3-5)
Middle/Junior High (6-8)
High School (9-12)
Community College
College/University

 Website Address (if any):

            School/Dept:

  

            Personal:

  

 Teaching Area(s):

English
Reading
Foreign Language
History/SS Studies
Science
Mathematics
Special Ed
Fine Arts
Physical Ed
Education Methods - Elementary/Secondary
Instructional Technology
Other

           If Other specify:

  

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Webmaster:  Tammy Banerjee
Graduate Assistant:  Kunal Bose
Last Updated: September 2, 2003