Registration Form for Teaching with Primary Sources (TPS)

Prerequisites: Classroom teacher K-12

Tuition and fees will be paid by the Governors State Teaching with Primary Sources Grant of the Library of Congress for the first 20 applicants.

Dates and Times

*Required Field
To be considered as a possible applicant, deadline for applying : August 15, 2012

*First Name:	Middle Initial:
*Last Name:
*Address:
*City:
*State:
*Zip Code:
*Phone:
*Email Address 1:
Email Address 2:
Employment
*Name of school district where you are employed:
*Name of school where you are teaching:
*How many years have you been teaching?
*What subject(s) do you teach?
What grade level(s) do you teach? (Hold down the Ctrl key to select more than one.)*
If you selected Other, please specify.
If high school, what are your course names?
	I understand that if my application is accepted that I agree to attend all sessions and commit to completing the course.
	If I drop the course after the drop deadline date, I will be obligated to reimburse the tuition and fees.