Registration Form : Texas Alliance for Geographic Education : Texas State University

Teacher Consultant's Summer Institute 2013

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First Name *

Last Name *

Preferred Name

Home Address

Home City

Home State

Home Zip Code

Work Address

Work City

Work State

Work Zip Code

Work Phone

Cell Phone

E-Mail *

ESC Region

School District

Current Title

Years of teaching experience

Current teaching experience (levels, subjects)

Courses taught

Education (Degree/Major)

Describe previous leadership experience, including roles as social studies coordinator, social studies instructional supervisors, and department chairs

Special Medical/Dietary Needs (TAGE cannot guarantee all food provided will meet your dietary needs.)

Would you like free housing in the Texas State dormitories? *

I agree that Texas Alliance for Geographic Education may use such photographs of me with or without my name and for any lawful purpose, including publicity, illustration, advertising, and Web Content. *

Yes

No

Applicant Certification: I agree to participate in all sessions from June 11-13, 2013. I will present at least one World Geography workshop in my district by December 2013. *

Yes

Please complete and mail or fax the payment and district certification form. You will need to get your district certification signature on the payment form.

Department of Geography

Texas Alliance for Geographic Education

News and Events

Resources

Registration Form

Teacher Consultant's Summer Institute 2013

Department of Geography

Texas Alliance for Geographic Education

News and Events

Resources

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Registration Form

Teacher Consultant's Summer Institute 2013