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I. General Information

Degree Objective Proposed Starting Date

I am interested in a graduate assistantship

In my first year, I will work on my program

Full time

Part time

II. Teaching Experience

Please describe your teaching experience using the chart below

III. Respond to the following in the space provided.

A. Previous graduate work
Please describe how your previous graduate work has helped you become a better science educator. How do you expect a doctoral degree to further improve your abilities.

B. Professional development activities
Please list any professional associations or professional development experiences (other than degree programs) in which you have been active in the last 5 years. Describe the type of activity and your role in it.

C. Leadership activities related to teaching
Please describe all leadership activities with which you have been involved that relate to teaching. These might include teaching an inservice class, serving on a school district committee, presenting at a conference, serving as an elected office of an organization or other such activities.

D. Experience in writing
Please provide at least one sample o your professional writing. This might include a paper you wrote or co-authored or a paper prepared for a class or a project. The writing sample should be at least 4 pages in length and should display your ability as a writer and thinker related to science education. More than one sample would be helpful.

E. Career Goals
Please describe your career goals. We understand that these goals may not yet be fully clarified, bu we ask that you share your present vision. Indicate how your goals related to obtaining a doctoral degree in science education, i.e., how will a doctorate assist you in attaining your vision?