MIDDLE SCHOOL SCIENCE INITIATIVE

 

DISTRICT APPLICATION

  

 

 

 

Name of District______________________________________

 

DISTRICT CONTACT INFORMATION

Name: Position:

Address:

City: State:

ZIP

Code:

Telephone: E-mail:

DISTRICT SCIENCE LEADERSHIP MEMBERS (4-5 MEMBERS; MUST INCLUDE A DISTRICT

REPRESENTATIVE, 7

TH GRADE REPRESENTATIVE – MAY INCLUDE OTHER GRADE LEVEL

REPRESENTATIVES AND OTHERS BASED ON DISTRICT NEEDS)

District Representative:

Position: E-mail:

 

7th Grade Representative:

Position: E-mail:

 

Team Member:

Position: E-mail:

 

Team Member:

Position: E-mail:

 

Team Member:

Position: E-mail:

PRELIMINARY LIST OF SCHOOLS FOR IMPLEMENTATION

 

  

 

  

 

  

 

  

 

  

 

PLEASE MAIL OR FAX BY SEPTEMBER 5, 2008 TO:

FLORIDA & THE ISLANDS COMPREHENSIVE CENTER

C/O DR. JOHN H. LOCKWOOD

1000 NORTH ASHLEY DRIVE, SUITE 312

TAMPA, FL 33602

PHONE: 800-756-9003 FAX: 813-228-0632