Name__________________________________________ Date_________________

Home Mailing Address_________________________________________________

School Name and Address_______________________________________________

School Telephone____________________ Home Telephone____________________

Fax Number________________________ Email Address______________________

Position Held with grade level____________________________________________

College Attended_____________________________ Highest Degree Attained_____

College Science Courses Taken___________________________________________

Science Workshops, Conferences Attended__________________________________

_____________________________________________________________________

Reasons for Wanting to Attend this Workshop ________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Although it is not required for you to have a letter of reference sent to us, we will use letters to decide on acceptance if too many applications are received.

• (Check) I will have a letter of reference sent from (name, address, and phone #):

___________________________________________________________________

___________________________________________________________________

I would like to attend the 1997 Summer Workshop on Science SOLs at UVa from July

7-25, 1997. I understand that I will be required to present an in-service activity at my local school and attend the follow-up session in March, 1998.

Signature__________________________________________________

Mail completed application and letter of reference by May 5, 1997 to Dr. Stephen Thornton, Department of Physics, McCormick Road, University of Virginia, Charlottesville, VA 22901.