Cohort 1 March 2 PD Registration

Cohort 1 Registration for March 2, 2013, Professional Development
Applicant Information
First Name*
Last Name*
Teacher ID Number
Your self-created teacher ID is used to identify you throughout the program. It is made of the last 4 digits of your home phone number (or cell phone if you do not have a home phone), your birth month, and your birthdate.

EXAMPLE: 5555-MM-DD

EXAMPLE: John Smith, born March 15th, at 212-555-5555

Teacher ID: 5555-03-15
LAST 4 digits of HOME phone number (use cell number if you do not have a home phone)*
Birth Month (i.e. January)*
Birthdate (i.e. 3rd)*
Teacher Contact Information
Work Email*
Personal Email You will receive your registration confirmation at this address*
Enter an e-mail you access even during vacation and summer months
Work Phone

Area CodePhone Number
Home Phone*

Area CodePhone Number
Cell Phone Number (Home phone if you do not have a cell phone)*

Area CodePhone Number
Do you give us permission to send text message reminders/updates to your cell phone? (Mobile phone text messaging charges may apply. Please consult your mobile phone service plan.)*

YesNo
School District Name*
County of School District*
Region (choose)*
School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Principal or Administrator Referral

Provide accurate contact information so we can work with your principal or administrator to assist you to attend training during the school year.
Please enter the name of the principal or administrator that referred you to this program:*
Please enter the email address of the principal or administrator that referred you to this program:*
Please enter the name of your superintendent:
Please Review the Description of the Professional Development Opportunity and then Register Below
March 2, 2013: AP Public Conference at Brooklyn Technical High School

29 Fort Greene Place, Brooklyn, NY 11217

This one-day conference, free only to teachers in the NY STEM Program, will offer the following 10 STEM subjects:

* Biology: Transitioning to Inquiry-Based Labs

* Calculus AB (Experienced)

* Calculus AB (New)

* Calculus BC

* Chemistry (Experienced)

* Chemistry (New)

* Computer Science A

* Environmental Science

* Physics B & C (Combined)

* Statistics

Please note: If you attended the AP Conference on December 1 or January 28, and plan to attend this conference too, you will need to register for a different subject to avoid repetition.
Register for this Professional Development Opportunity (please choose one)
March 2, 2013, Brooklyn Tech AP Conference*

Biology: Transitioning to Inquiry Based LabsCalculus AB (Experienced)Calculus AB (New)Calculus BCChemistry (Experienced)Chemistry (New)Computer Science AEnvironmental SciencePhysics B & C (Combined)Statistics
Thank you for registering for more exciting professional development! Please click below to submit your registration!
Questions/comments/problems?
Should be Empty:

Cohort 1 Registration for March 2, 2013, Professional Development

Applicant Information

Teacher ID Number

Teacher Contact Information

Principal or Administrator Referral

Please Review the Description of the Professional Development Opportunity and then Register Below

Register for this Professional Development Opportunity (please choose one)

Thank you for registering for more exciting professional development! Please click below to submit your registration!