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Name
Home Phone
Home Address
Email
School Name
School Phone #
School Address
Number of years teaching?
Number of years teaching physics/physical science?
Do you have any conflicts with the scheduled meeting dates?
Workshops you have taken in the last five years? Include topic, location, and dates
Describe what you have done that is innovative for a course, your department or your school
Education
Degree Field Year _____________ _______________ ___________ _____________ _______________ ___________ _____________ _______________ ___________
Number of formal courses in physics?
What research experience have you had?
What research experience have you given your students?
Describe what you have done (if anything) with particle physics in your curriculum
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