Personal Information

Name (last, first middle):

Your email address (required or application will not be processed. If you don't have an email address, type "noemail@uchicago.edu"):

Home address (line 1):

Home address (line 2):

City/State/Zip:

Home telephone (including area code):

The following two pieces of information are required for registration at the University of Chicago:

Social Security Number:

Date of Birth:

School or business name:

School or business telephone (include area code):

School or business department:

Choose one: My school is a(n) --choose one-- elementary school middle school high school I don't work in a school other

How many years have you taught at this school? ---choose one--- One year or less Two or three years Four to six years Seven to 10 years More than 10 years

How many total years have you taught? ---choose one--- One year or less Two or three years Four to six years Seven to 10 years More than 10 years

What is the magnet cluster focus of this school, within the Magnet Cluster Initiative?

Choose one.... Math/Science Fine/Performing Arts World Language Literature and Writing International Baccalaureate International CPS Scholars Other/don't know

What is the name of your neighborhood cluster? (If you don't know, write "don't know.)

Have you ever attended the Web Institute for Teachers (or WWW for Teachers) before? Yes No

If so, what was the last time you attended? ---choose one--- 1997 1998 1999 2000 2001

Describe a learning experience you recently created for students or learners:

Which platform is more familiar to you? 
Macintosh
Windows 
Either (doesn't matter which one I use)
 

How many times a do you sit down to send and receive emails?:
Less than once a week
1 - 2 times weekly
3 - 5 times weekly 
daily 

Please rate your familiarity and experience with the following software:

Software	No use	Little use	Some use	Extensive use
Netscape Composer (web page editor)
Microsoft FrontPage (web site editor)
Macromedia Dreamweaver (web site editor)
Adobe Photoshop (image editor)

 

Please rank in order of importance your interest in the following topics. (Simply by typing numerical values, the number 1 representing highest importance and 6 the least important.):

	Create lists of bookmarks and on-line lists of links
	Use advanced software tools to plan, design, and implement a Web site
	Build a Web-based project that can support a sustained process of learning for your students
	Use advanced graphics editors to modify or create images
	Include simple sounds and video on a Web page
	Teach others how to use the Web to support teaching and learning

Please rank your skill level in the topics listed below:

 Utilizing an Internet search engine in order to obtain desired information:
  skilled
  somewhat skilled
  not skilled

Choosing an effective Internet search engine for the task at hand:
  skilled
  somewhat skilled
  not skilled

Evaluating Internet-based resources and instructional materials in terms of their likely effectiveness for specific purposes:
  skilled
  somewhat skilled
  not skilled

Enter the URL (address) of a web site that you find particulalry useful in your work (teachers, for example, may choose to enter a site that is referenced frequently for lesson plans, or that is somehow useful in teaching students; administrators may choose to enter sites that promote the integration of technology into learning).

Explain why the above site is useful:

Please answer the following questions using your favorite online search engine. Please enter your responses in the text boxes provided.

Find the Chicago Tribune daily weather site (with weather reports from Tom Skillings). Enter the URL of the web site below:

Find the web site for the Illinois State Board of Education. Enter the URL of the web site below:

 

Find George W. Bush's birthdate. Enter it here:

Given the opportunity to develop a web site related to your school's magnet cluster focus, think of a topic you would like to consider. (Please note that you are in no way required to pursue this topic once WIT begins.) What is the topic?

Find a web site that relates to this topic and put the URL here:

Based on your experience filling out this form, do you feel you are ready for "Creating a Curriculum Web?
Yes, definitely.
Probably. But I'm ready for the challenge.
I honestly don't know.
Maybe not.
Definitely not.

Anything you would like to add?

If you are selected to participate in the WIT 2004 Special Section for the Magnet Cluster Initiative, you will be expected to do the following. Please indicate your agreement to do these things by selecting "yes" for each of the following:

I will attend WIT 2004 from July 6 to July 23, 2004 , 1 pm to 5 pm.

Yes No

I will implement the project that I produce in WIT 2004 during the first marking period of the 2004-2005 school year.

Yes No

I will participate in follow-up meetings in September and November of 2004 and February of 2005.

Yes No

I will present my project to other teachers in my magnet cluster.

Yes No

 

Your submission of this form counts as a signature on this form.

Personal Statements

Please explain the role that email currently plays in your personal and professional life. Include how often you use email, what you use it for, what software you use, and any discussion groups or listserves you subscribe to.

Describe the current availability of computer equipment and software at your school and in your classroom. Be sure to include mention of Internet accessibility.

Describe your use of computers for instruction or to support instruction during the 2003-2004 school year. (Such use is NOT a requirement for admission to the Institute.)

Describe your home computer system.  Include a description of your connection to the Internet.

Please describe your interest in the Web Institute for Teachers and how you expect it to affect your teaching effectiveness.

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Incomplete applications WILL NOT be considered.

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