OLD - STEM Innovator® Professional Development Information - Onsite

I am accepting my spot in... *

Personal Information

First name *

Last name *

Email address *

Home address *

City *

State *

Zip *

Phone *

School Information

School name *

Principal's name *

Principal's email address *

Principal's phone *

School district *

City *

State *

County *

Zip *

In which Iowa STEM Hub Region is your school located in? *

Superintendent's name *

Superintendent's email address *

Superintendent's phone *

In what ways is your School Administration committed to supporting your STEM Innovator® team over the course of the school year? *

Teaching Information

Which subjects are you certified to teach? *

Which subjects do you currently teach? *

Years teaching experience *

Profile Description *

Please write a brief profile of your professional life in the third person (i.e. do not use "I"), including ways you have been innovative in education. Possible topics include education, subjects areas taught, coaching, accolades, leadership, unique experiences, career highlights, etc. See an example of a profile.

Photo *

Please upload your most recent school yearbook photo or a professional looking photo with a solid background. Selfies, photos with spouses and/or children cropped out, and silly faces are photos that do not meet the guidelines. If possible, a high resolution image is preferred.
Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png bmp tif.

Terms of Agreement *

Yes, I give permission

No, I do not give permission

I give permission to use my information in a published document to showcase certified STEM Innovator® teachers.

Team Information

One team member from each team must complete this section. Answers should be written collaboratively by the team. If you are not on a team, please make sure you still fill out this section.

Team members *

If applicable, list your team members, in alphabetical order by last name.

Team Communication Plan *

How do you plan on communicating with your team members? If you have other teachers at your school involved in STEM Innovator, but aren't going through this scale up program with you, how will you communicate with them (i.e. during the week long training AND after the week long training)? Will you text, call, email, have regular meetings to collaborate, or...? List your plan to communicate here.

School Description *

Please submit a brief description of your school or school district. Please include demographic data, unique features, opportunities, areas of focus, and challenges.

Community Description *

Please submit a brief description of your community. Please include unique features, opportunities for engagement, and challenges.

What is your team's vision for engaging students in problem based learning with community partners to support STEM innovation, entrepreneurial thinking and development of 21st Century Skills? *

Onsite Lunch Information

Please list any dietary restrictions (i.e. vegetarian, gluten free)

Dietary Needs *

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