Online Application For Schools 2009-2010

Instructions

The contact person for the region as well as each school's contact person must fill out the application by Thursday, October 15, 2009 .

Section 1: District Contact Information and Presentation Schedule

This section only needs to be filled out by the District Contact Person.

* Your Name :

* Your City, State :

* Your District :

* Your Neighboring Districts :

* Are you also serving as the contact for your school? Yes No

* What is your affiliation to this district? (i.e. counselor at XYZ HS or XYZ district's engineering curriculum designer):

* Is the district urban/suburban/rural/etc? :

* What are the closest airports (local and international)?

* What is the weather like in January?

* Have you applied before, if so when and how many times? Were you the previous coordinator, if not what was his/her name?

Contact Information:

* Work Number : ( ) -

Best Time to reach you :

Cell (if available) : ( ) -

Best Time to reach you :

* Email address :

* Which of the above fields do you prefer we use to contact you?

* Please list at least 6 participating schools in your district. If your district does not have at least six middle and high schools, we encourage you to coordinate with nearby school districts to send in one complete application.

Include name, type of school (middle vs. high, private vs. public), and a school contact person (name and contact method).

PLEASE CONTACT EACH OF THESE SCHOOLS FIRST AND VERIFY ITS INTEREST IN PARTICIPATING BEFORE SUBMITTING ITS NAME AS PART OF YOUR DISTRICT APPLICATION.

We encourage inclusions of inner city and rural schools, or schools with a significant percentage of underprivileged students.

School Name and District	School Type	School Contact

Our presenters will travel in January 2010. Please rank your preference on the weeks of Jan 2010 for your presentations. We will try to accommodate your first 1st choice, but cannot guarantee it. Please rank only weeks during which you can have presentations.

* First Choice :
* Second Choice :
Third Choice :
Fourth Choice :

Section 2: School Information

Each question should include a response from each participating school. Please compile answers from individual school contacts.

* For each school, please briefly describe the economic and ethnic background of the students.

* How will each school select students to attend the presentations?

* How many students can each school accommodate during the presentations? (How many presentations, and how many students per presentation)

* What kinds of engineering or science programs have been implemented (or will soon be implemented) in your district?

Examples include magnet programs, AP curriculum, other advanced programs, student participation in math and science fairs and competitions, and academic clubs.

* Why do you believe the MIT Women's Initiative Program would make a particular impact on the female students in your district?

Do you have any comments or suggestions for us?

NOTE: Before submitting, please be sure that the application is completely filled out as we will not be considering incomplete applications. This form does not save work in progress.

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