Deadline for Application and Supporting Documents: May 20, 2013.

Summer Institute:  July 8-12, 2013

Application requires (1) signed Memorandum of Agreement from school principal and (2) Letter of Recommendation from principal or science supervisor.

Email or fax completed application or submit online by May 20, 2013.

(Recommendation and Memorandum of Agreement must also be received by application deadline.)

Beth Hines, Curriculum Specialist

Peabody Fellows Biodiversity & Human Health Program

Yale Peabody Museum of Natural History

P.O. Box 208118

New Haven, CT 06520-8118

(203) 432-5715 Fax (203) 432-9816 peabody.fellows@yale.edu

Once you have completed the application below, please download the Memorandum of Agreement for School Principal. You can then either fax it to (203) 432-9816 or scan and email it to peabody.fellows@yale.edu.

Name: *

Home Address: *

City: *

State: *

Zip: *

Phone(s): *

Primary Email: *

Other Email(s):

School: *

School District/County: *

School Address: *

School City: *

School State: *

School Zip: *

School Phone: *

School Fax: *

Grade(s): *

Number of Classes: *

Number of Students: *

School Type: *

Urban

Suburban

Rural

Student Body: *

Under 500

500-1000

Over 1000

Principal's Name: *

Subject(s) Currently Teaching: *

Academic Background: *

Teaching Experience (Include grades, subjects and number of years.): *

Do you expect to be teaching the same grade(s) and subjects(s) in the next school year?: *

Have you participated in a teacher professional development program offered by an informal science institution (museum, nature center, science center, zoo, etc.): *

Do you regularly use a museum or other informal science institution in your curriculum: *

Do you have previous experience with Yale Peabody Museum programs?: *

Where did you hear about our program?: *

CSTA newsletter

Connecticut Science Connection e-newsletter

Yale Peabody Museum website

principal

science supervisor

other teachers

Other (please explain)

Other (please explain):

Is there any additional information you would like to supply that you feel would aid us in evaluating your application?: *

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