Registration Form

Registration Form
Your name & title *
# of students
Principal's name
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School
District
Is another teacher working with you to present this unit of study? *
Other teacher's name
Grade *

4th 5th 4/5 Combo 5/6 Combo
Comments / Special request
Phone Number *

- Area Code Phone Number
E-mail *
Desired Unit

Electricity (5 lessons) Magnets (4 lessons) Rocks/Minerals (5 lessons) Erosion (4 lessons) Ecosystems and Adaptations (4 lessons) Ecosystems and Energy Flow (4 lessons) Matter (5 lessons) Scientific Method (5 lessons) Gravitational Force (4 Lessons) Waves (4 lessons)
Desired date of unit delivery:
First Choice Date

- Month - Day Year
Second Choice Date

- Month - Day Year
Third Choice Date

- Month - Day Year
By clicking SUBMIT, you acknowledge the following:

1. I have received approval from
my campus principal to participate in the
Science 4 Kern program.

2. I understand Science 4 Kern's units are designed
for a maximum of two teachers.

3. I understand that units may only be kept on
my school site for a maximum of 15 school days.

4. I have checked my calendar to ensure that the
adequate timedays I have requested adequate time
to competed the unit's lessons.
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