Registration Form

 

Training of Trainers

May 9-10, 2007

Great Wolf Lodge, Wisconsin Dells, WI

 

 

Name                           ______________________________________________________

 

School District             ______________________________________________________

 

School Building             ______________________________________________________

           

School Address              ______________________________________________________

 

City/Zip                       ______________________________________________________

 

Phone                          (W)___________________________  (H)__________________________

 

FAX                             ______________________________

 

Email                           ________________________________________ (preferred method of communication)

 

Please complete (Check one)

 

_____  Teacher

_____  Teacher Aid/Assistant

_____  Other School Staff

_____  School Administrator

 

All above information required.  Confirmation will be sent via email.  After attending the free workshop, you will be required to complete a 2-sided Match Record, due by July 1, 2007.  Attendance at both days of the conference is required from 8:30am-3:30pm or free credit cannot be awarded.  Please initial that you understand these requirements _______. 

 

Email, Fax or Mail to:                         Heather Graves

                                                            UW-Stout

                                                            11 Harvey Hall

                                                            Menomonie, WI 54751

                                                            FAX: 715-232-1985

                                                            Phone (W) 715-232-1395 (or 715-232-1131)

                                                            Email: gravesh@uwstout.edu

 

* UW-Stout credits will be awarded in August 2007.  Registration for the credits will take place during the workshop. 

 

Continued to next page RETURN PAGES 1 & 2 TO REGISTER

Registration Form

 

Training of Trainers

May 9-10, 2007

Great Wolf Lodge, Wisconsin Dells, WI

 

Name      __________________________________ RETURN PAGES 1 & 2 TO REGISTER

 

Please provide us with some information about your experience with Family Math/Family Science/Playtime is Science so we can order materials and select a curriculum.

 

 

Leadership Workshop Experience. Please indicate the programs in which you were trained and indicate which books you have.  These were given free of charge during the workshop that you attended. 

 

Workshop                                          

 

___ Family Math and Family Science, Fall 2004

___ Playtime Is Science and Family Math for Young Children, Fall 2005

___ Middle School Family Math and Family Science, Fall 2006

___ Prior workshop, list title and date: ____________________________________________

 

Please indicate the books that you already have: _____________________________________________

____________________________________________________________________________________

 

 

 

Parent/Child Workshop Experience. Please provide details about your experience with offering parent/child workshops in Family Math, Family Science, and/or Playtime is Science. Indicate the name of the program(s) in which you have presented parent/child workshops and then provide the dates, locations, and student ages.

 

Program                                       Dates/Locations                                        Student Ages

 

Family Math                                  _______________________________    _______________

 

Family Science                               _______________________________    _______________

 

Family Math for Young Children   _______________________________    _______________

 

Playtime is Science                         _______________________________    _______________

 

Middle School Family Math           _______________________________    _______________

 

 

Activity Knowledge. Please name the ten Family Math/Family Science/Playtime is Science activities that you would be most comfortable teaching others to utilize.