Pre-Service Teacher Application

Name:

Email address:

Home Address:

City: State: Zip Code:

Mobile Phone:

I will be able to attend the Pre-Workshop June 27-28, 2012 Yes No
I will be available to work in a BU lab from 9-5 M-F July 2-August 10, 2012 Yes No

Please indicate grade levels for which you are preparing to teach: (Check all that apply.)

Major in college:

Minor in college:

Highest Degree Earned:
Bachelors
Masters
PH.D.

Please list all courses you took in 2011-2012:

Please list subjects/grade levels you are preparing to teach:

Have you secured a teaching position for 2012-2013? Yes No
If Yes, please indicate school and district:

Please provide names of two individuals who will submit profesional references for you through our online form: http://www.bu.edu/lernet/ret/rec.html
One form should be completed by your supervising teacher and another by a professor or academic advisor.

Student Teaching Supervising Teacher

School Name

Email:

Telephone:

Current (or Past) Professor or Academic Advisor:

E-mail: Phone:

Please indicate your choice of lab placement based on the laboratory descriptions in order of preference numerically from 1-5 where 1 is your top choice.

Detection and capture of proteins and antibodies
Wavefront control and adaptive optics
Vortex states of type II semiconductors
Temperature sensors, magnetic field measurements, particle counter and electronics
Microscopy, endoscopy, 3-D and phase contrast imaging

1) Why are you interested in an RET in Biophotonics?

2) Have you participated in any other RET or research-based program? If so, please describe.

3) Please describe any previous STEM courses you have taken or STEM workshops you have participated in.

4) Please describe any previous experience with programming, web-based programs, or instrumentation (e.g. LabView, MatLab, HTML, website tools, etc.).

5) How do you see the RET experience helping you to become a STEM leader?