Name:

Gender: Female      Male

Home Mailing Address:

Street:
City:
State:
ZipCode:

Home Phone:

School Name:

School Mailing Address:

Street:
City:
State:
ZipCode:

School Phone:

Age Range: 20-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 65+             Computer Expertise: Beginner Intermediate Advanced  

Software Usage:   Word Processing   Spreadsheet    Presentation    Database

                            Statistical Programs   Internet   E-mail   Special Tech Programs (ArcView, etc.)

Grade Levels for Project Implementation:

Number of Classes:           Years Teaching Experience:

Major Teacher Specialization:  History    General Science    Computer Technology   Gifted/Talented

                                               Mathematics   Language Arts   Social Studies   Other

Educational Preparation: B.A.   B.S.   M.A.   M.S.    M.Ed.

Indicate level of technology you have included in your curriculum prior to this project: