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:

**FULL** Seminar I: Monday June 17 AND Wednesday June 19
Reinventing Shakespeare: Bringing the Bard to Life for 21st-century Teens

Seminar II: Monday June 17 AND Wednesday June 19
Religion and the American Founding

Seminar III: Tuesday June 18 AND Thursday June 20
Teaching Politics through Film

Seminar IV: Tuesday June 18 AND Thursday June 20
Allah or God? Can Muslims and Christians Work Together in Peace?

**FULL** Seminar V: Tuesday June 18 AND Thursday June 20
Available Means: Writing, Reading and Rhetoric in a Digital Age

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