HU-LINC

TAKS-Based High School Mathematics/Science Institutes
Application Form

c  Initial (new participant)


(<------Check ONE)
Fall 2003 - Summer 2004
(See e-TRAIN for course description details and meeting schedule)
NO Course Fees -- FREE!

c Advanced ( 60+ hr previous)

c C3 Coach (100+ hr previous)

 NOTE:  Each campus may submit multiple mathematics/science teachers for consideration.
Each individual teacher applicant must complete a separate form.  Please provide the following information:

Indicate your content area(s) assignment (check all that apply): 
c  Algebra I         c  Geometry       c  Algebra II        c  Pre-cal/Calculus
c  IPC                   c  Biology           c  Chemistry       c  Physics


Name_____________________________________
          (last name, first) 

HISD Employee #  __ __ __ __ __ 

HISD E-Mail: _________________@houstonisd.org

Alternate E-Mail:_____________________________
Home Mailing Address: __________________________________________


School_______________________________________
Admin. District______________ Campus # __ __ __
School FAX     ___________________
School Phone  ___________________
Evening  Phone ___________________
Alternate phone or pager # ____________________

City___________________ ZIP _______________

 What daily schedule format does your school follow?
____ Traditional (6-7 periods/day)
____ Alternating Block (A-B days)
____ Accelerated Block (9 wk semesters)
____Other: ___________________________________

 Are you currently teaching within a “small learning
community?"   c  Yes      c  No
If so, describe your role within this structure:
_____________________________________________
_____________________________________________

APPLICANT SIGNATURE:   I am committed to participate in the full year of professional development in
TAKS-based content connections, technology skills, and integrated applications. 
Teacher
Signature__________________________________________________ Date_________________


PRINCIPAL:  (must be completed by campus principal)
I recommend and support the certified teacher identified above to represent my school in this professional
development program. 
Principal
Name________________________________ Principal Signature____________________________
 

Please mail this form to: Mable Humphrey, HU-LINC, Weslayan Building B-210, Route 10
or FAX to 713-892-7126 by September 5, 2003
For questions, please call 713-892-7749 or 713-892-6915
Website:  http://com.houstonisd.org/hulinc