HU-LINC
Middle School or Elementary
On-line Application to Offer
Professional Development Courses

The following application will be reviewed for teacher needs and qualities of offering for MIDDLE SCHOOL or ELEMENTARY level.  You must indicate appropriate content area for Middle School or Elementary, based upon grade level of offering.   Please provide the following information:  (Refer to RFP Description for explanation of items requested.)

Semester Offered	(Select one per submission) Fall 2003 Spring 2004 Summer 2004
University/College*
Course Title*
Instructor(s)
Middle School Content Area(s)	(Select one) Science/Math/Technology Science Mathematics Science/Mathematics Mathematics/Technology Science/Technology None-This is an Elementary Course Choose from: Math -- Science  --  Technology -- or any combination
OR  Elementary Content Area(s)	(Select one) Earth Systems Integrated Math/Science/Tech Living Systems Mathematics Physical Sciences ("Elem IPC") STC Kit-based Inquiry Choose from:  STC Inquiry Kits  --   Elementary IPC  --  Living Systems   --  Earth Systems  --  Integrated M/S
Grade Level(s)*	(Select one) PreK-1st Early Ed K-2nd Primary Elem K-6 Elementary 3-5th Intermediate Elem 3-6th Adv. Elem 6th Grade 6-7th Grade 6-8th Grade 7th Grade 7-8th Grade 8th Grade K-12 General 6th-12th Secondary 9-12th High School Only
Participant Restrictions	(Ex:   HU-LINC Mentors only;  ...who have completed [prior course]; recommended for IPC teachers)
PRINCIPAL CONTACT PERSON for this course:
First name*	MI
Last name*
Title*	(Select primary role) Project/Program Director Instructor Professor Project/Program Coordinator Project/Program Supervisor Adjunct Professor Assistant Professor
Work Phone*
FAX*
E-mail*
Course URL
Begin-End Dates of Course*	(Example:  Sept. 10, 2003 - Dec. 14, 2003 --OR-- 9/10, 9/12, 9/25, 10/15...)
Start-End Time each day*	(Example:  4:00 pm - 6:00 pm, Tuesday - Friday)
Room #/Floor*
Building Name*
U/C Campus*
Street Address*
Parking Lot(s)*
COURSE DETAILS/BENEFITS INCLUDED
Type of Credit*	(Select one) Graduate Credit Available Undergraduate Credit Available Continuing Education Credit Available Professional Development Hours Only
# hours Credit	(Select one) 1 credit hour 2 credit hours 3 credit hours 4 credit hours 6 credit hours No official hours - Prof. Dev. Only
Gifted/Talented	Does this course meet G/T requirements? Yes    No  # hours
Credit-Granting Institution	Which university/college is providing credits, if any?
Target Content Objectives
Technology Included, if any	Calculators Graphing Calculators	Probe Ware Microscopes	Computer Applications Digital Cameras
Other Technology (describe)
Pedagogy
Brief Course Description for Catalog
Requested Funding	Instructional Materials: Coursework consumables are included in the $500/teacher allocation.  Teacher take-home classroom materials of $250/teacher will be reimbursed by receipt, following completion of the course offering. Other: $  (if any)
Other Funding	What other sources of funding, if any, will be used for this course?  (list source and amounts)
Stipends	HU-LINC provides $300 stipend per course for each qualified teacher-participant.  If your funding provides additional stipend/benefits for participants, please describe each:
Detailed Course Description	If this is a new or revised course, please FAX or e-mail your program description to: FAX 713-892-7126 or e-mail:  chaynes@houstonisd.org
VITAE	If a current vitae is not on file with HU-LINC, please FAX or e-mail your Vitae to: FAX 713-892-7126 or e-mail:  chaynes@houstonisd.org
NOTE:  The principal contact person will be notified within two weeks following the deadline (shown at top) if this proposal has been accepted.  For questions on proposals, contact Charlotte Haynes via e-mail at:  chaynes @houstonisd.org or call the HU-LINC office at 713-892-6915. IF YOU HAVE DIFFICULTIES WITH THIS FORM, CONTACT Gaye Wunsch by e-mail at:  gwunsch@houstonisd.org, or call 713-892-6916