Name________________________________________

Home Address________________________________

City, State, Zip_________________________________________

Home Phone_____________________

E-mail_______________________________________

School_______________________________

School Address___________________________________________

School Phone_________________________

Subject(s) and/or grades taught:

________Please reserve a space for me at the Kickoff Workshop on July 10 + 11, 2008.

(Note: attendance at the Kickoff is mandatory).

________Please reserve a space for me at the orientation breakfast on Saturday, July 12, 2008.

(Details about the Kickoff Workshop and orientation breakfast will be furnished upon acceptance to the Institute)

________I have enclosed an application

________I have enclosed at least one letter of recommendation from an administrator or department

head in my school

________I have enclosed a statement of my reason for wishing to attend the Institute