Deadline Extended till Friday, April 29

Application Form for GeoSCOPE Teachers Workshop

Geoscience Enrichment Activities for Teachers

Tuition waiver or stipend

Please return this form in order for us to reserve a tuition waiver or stipend for you, no later than April 27, 2005. We estimate that we will be able to provide at least 15 waivers or stipends of $400 each. Waivers (applied directly to tuition) do not have taxes deducted. Stipends (paid to you as a check at the end of the workshop) have taxes deducted from them.

Which do you prefer: Waiver _____

Stipend _____

Your name________________________________________________________________

School where you teach _____________________________________________________

Courses that you teach______________________________________________________

Grade levels_______________________________________________________________

Contact information:

Address:__________________________________________________________________

Phone:________________________________

e-mail:________________________________

Please send this form by e-mail to: hickey@fiu.edu

OR by regular mail to: GeoSCOPE

Department of Earth Sciences

Florida International University

Miami, FL 33199

OR bring it to: Department of Earth Sciences

Charles Perry Building PC 344

University Park Campus (SW 107th Avenue & 8th Street)

Florida International University

Note: The last day to register for this course is May 4, 2005. If you are not currently taking classes at Florida International University, you will have to enroll as a non-degree seeking student in order to register for the course. Instructions for doing this can be found through the FIU registrar at: http://www.fiu.edu/orgs/register/special.htm. Once enrolled, you will be given a PIN that you can use to register.