School Name:

Office Phone:

School Address:

Teacher Information

First Name: Last Name:

Subject(s) and Grade Level(s) Taught:


Home Address:

School Phone (Ext):       Home Phone:

School Email:

Home Email:

What is the best email, phone and address to contact you during the summer months:
Home    School

What is the best email, phone and address to contact you during the school year:
Home    School

I am applying to attend the following RSSIT 2008 Workshop(s):

Simple Simulation Gaming (June 23 - July 11)
Eco-Mapping: Beyond the Mercator Map (July 14 - July 25)
Gaming Bootcamp for Educators (July 28 - August 15)

May we contact your pricipal regarding your participation in RSSIT? Yes No

Principal Name:

Principal Phone:

Principal Email:

We will provide you with the necessary software and work with your technology support staff.

Technology Person:

Phone:

Email:

I have read the RSSIT project description and requirements, including the school, teacher and technical support personnel commitments required for participation and implementation. I agree to participate in the RSSIT project as described, including training, integration of project materials into the classroom and participate in the online support conferences.

Yes No

Tincan will provide travel reimbursements. Once you have been selected to be a participant of RSSIT we will contact you to make the appropriate travel arrangements.