Family ASTRO Event Leader Training Application Form
Fax to Kristin Nelson (415) 337-5205, or send to Family ASTRO, Astronomical Society of the Pacific, 390 Ashton Avenue, San Francisco, CA 94112
Applications are due by Friday, September 24, 2004. (Late applications may be accepted, if space allows.)
Contact Information
Name ______________________________ School/Organization_____________________________
Address (street/city/zip): _______________________________________________________________
Phone: __________________________________ E-mail: ___________________________________
__ I am new to your project.
__ I have been involved with Project ASTRO.
__ I have attended
a Family ASTRO training event before an learned to facilitate the following
kit(s)
(circle all that apply): Race To The Planets Moon
Mission Night Sky Adventure Cosmic
Decoders
I rate my knowledge
of the night sky on a scale of 1-10 (1=little knowledge, 10=very knowledgeable)
as: ____
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I am a (please check all that apply):
__ elementary school teacher __ middle school teacher __ high school teacher
__ amateur astronomer __ professional research astronomer __ retired research astronomer
__ graduate student/Post Doc __ community/youth group leader __ museum/planetarium educator
other _____________________
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Are you bilingual? What languages do you speak?
________________________________________________________________________________________________________________
Why are you interested in participating in this program? What goals related to Family ASTRO do you have?
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
What is the name of the organization that will host your Family ASTRO Event(s) and where is it located?
________________________________________________________________________________________________________________
By signing this form and attending the leader training, I agree to lead at least two family events within the next 12 months, and to work with Family ASTRO staff to help evaluate the program.
If I am a teacher, I certify that I have the approval of my principal or other administrator to participate in this activity.
Signature ______________________________________ Date _________________________