GEMS Associate's II Professional Development Application
Use this form to print out and FAX your application or apply online.
Please note: Only GEMS Associates
are eligible to apply for Associate's II.
Name _______________________________________________________________
(as you would like it to appear on your name tag)
Partner's Name (if applicable)_______________________________________________
Institution/Work Address_______________________________________________________________
City ________________________ State ______ Zip __________
Work Phone
____________________
Position ___________________________________ Grade Level Involvement
_________
Home address
_____________________________________________________________________
City ________________________ State ______ Zip __________
Home Phone
____________________
Email ________________________
Which GEMS Associates Workshop did you attend? __________________________________
Are you affiliated with a GEMS Site or Center? _______ If so, where?___________________
Visa or MasterCard accepted (please include: Cardholder's Name, Card
Number, Expiration Date). Make check/purchase
order to: Regents of the University of California
Associates II Professional Development:
Poster Session 4-6 PM May 9th;
remaining sessions 8:30-3:30 May 10—12, 2005.
- Associates II Fees:
- $430 per person; $395 per person for two or more attendees.
Fee includes reception, workshop fee, parking, and lunch each day.
Travel and lodging not included.
Associates II Applicants
Your application will be evaluated based on your responses to these
questions. Please attach a separate sheet of paper.
- How are you currently using GEMS in your role as
an Associate? (Please give detailed information)
- What do you hope to gain from the Associates II Seminar?
- What do you feel you have to contribute as a participant?
- Mail application and payment to:
University of California, Berkeley
GEMS Professional Development
Lawrence Hall of Science # 5200
Berkeley, CA 94720-5200
Questions? Call GEMS at (510) 643-0672
GEMS Professional Development
|
