Name:

Email address:

Home Address:

City: State: Zip Code:

Mobile Number:

School:

School Address:

City: State: Zip Code:

School Phone Number: School Fax Number:

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

I teach these grade levels: (Check all that apply.)

Total Years of Teaching Experience (in all schools)

Major in college:

Minor in college:

Highest Degree Earned:
Bachelors
Masters
Ph.D

Please list all subjects that you taught in 2011-2012:

Please list all subjects that you will teach in 2012-2013:

Please provide names of two individuals who will submit professional references for you through our online form: http://www.bu.edu/lernet/ret/rec.html
(Please note, teachers accepted into the program will need to provide a letter from their principals confirming that they will be granted three professional days for callback sessions during the coming AY.)

Principal:

E-mail: Phone:

Professional Reference #1:

E-mail: Phone:

Professional Reference #2:

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. To view descriptions, please open this link in a new window: http://www.bu.edu/lernet/ret/projects

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 Professional Development experiences.

4) Please describe your experience with technology and what educational technology you regularly use in the classroom (SMART Boards, iPads, etc.).

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

6) Please describe any STEM Leadership role you have assumed in your school or district.

7) Please describe how the RET will improve your potential to be a STEM leader.