Each year OSC invites two high school teachers to assist with Summer Institute. Applications for consideration are accepted February 10, 2015 through April 28, 2015. Teacher Profile Name * Last Name, First and MI Name for Name Tag * Number and Street Address * City * State * - Select -ALAKAZARCACOCTDEFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVIVAWAWVWIWY Zip Code * County of Residence * - Select -AdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFayetteFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHockingHolmesHuronJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMercerMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPauldingPerryPickawayPikePortagePreblePutnamRichlandRossSanduskySciotoSenecaShelbyStarkState Level SitesSummitTrumbullTuscarawasUnionVan WertVintonWarrenWashingtonWayneWilliamsWoodWyandot Primary Phone Number * E.g., (123) 456-7890 Email Address * School * School District * Years as a Teacher * Subject(s) You Teach * Grades You Teach * 9th 10th 11th 12th Other Grades You Teach Other Interests/Hobbies * Computer Programming Experience (This will not be part of the criteria for admission.) Gender * - Select -MaleFemale Professional References Reference Name * Last Name, First and MI Reference Primary Phone * E.g., (123) 456-7890 Reference Secondary Phone Additional Reference Name * Last Name, First and MI Additional Reference Primary Phone * E.g., (123) 456-7890 Additional Reference Secondary Phone Short Answer Question What interests you about Summer Institute? If you have any specific goals in mind, please list them. How can you contribute to the program? * How did you hear about Summer Institute? OSC WebsiteFriendTeacherParentStudentLibraryScience OlympiadOhio Education Technology ConferenceEmailPostcardOther How did you hear about Summer Institute? Other
