Professional Development Services Application

Please fill in the following information and press the SUBMIT button. To receive more information about Professional Development Services, please complete the form below. The form can be submitted here or printed out and faxed directly to Liz Pabon at 914-273-2227. After receiving your application, our department will contact you to discuss further details and fees. Fields marked with red are required!

Name*

Title:

District/School:

Phone:*

Address:*

City:*

State:*

Zip:*

Country:

E-mail:*

Fax:

Curriculum:

Active Biology

Active Chemistry

Active Physics

Active Physics CoreSelect

Active Physical Science

Aim for Algebra

Astrobiology

BioComm

Coordinated Science for the 21st Century

EarthComm

Integrated Coordinated Science for the 21st Century

InterActions in Physical Science

Investigating Earth Systems

Investigations in Environmental Science

MATH Connections

PET, PSET, ESET

PBIS - Project Based Inquiry Science

Middle School Inquiry Science

Curriculum has been:

Adopted

Piloted

Field tested

Have you received any type of training?

Yes

If yes, when, and how many days?

Check the type of Professional Development you are interested in:
Implementation Workshop	Introductory Workshop	Follow-up Workshop
Leadership Institute	Regional Summer Institute	Mentoring Visit
Phone Consultation	Technology Training

School Enrollment:

Number of students impacted:

Number of teachers to be trained:

Preferred Workshop Location and Dates:

Please explain briefly how you plan to implement or are implementing the program in your school.