Teachers as Scholars Registration Form

Last name:
First name:
Teaching field:
Teaching level:
Home Address:
City:
State:
Zip Code:
7-Digit Professional ID #:
(*required for ACT 48 Credit request)

School:

School district:
Work telephone:
Cell phone:
E-mail address:
Best way to contact you:


1st Preference


2nd Preference

Please select the seminars you would like to attend:

Seminar I: Monday June 16 AND Thursday June 19
The "Slave Narrative": Critical Conversations on Literacy, Liberty, and Life
Seminar II: Monday June 16 AND Thursday June 19
Rethinking the American Colonies
Seminar III: Tuesday June 17 AND Friday June 20
Digital History

Seminar IV: Tuesday June 17 AND Friday June 20   Techology and Learning Strategies


Seminar V: Wednesday, June 18   Digital Toolbox

Reason for interest in these seminars:
Teacher's Signature:
Date: