Application (PHP)

Name

Position

College

Address

Email

Work Phone

Housing Information

Male Female

Special Needs
(disabilities,
dietary restrictions,
spouse/family housing,
etc.)

Prior Workshop Attendance

I have previously attended a Paradigms Workshop
I have never attended a Paradigms Workshop

Statement of Interest
& Expected Impact
(e.g. teaching experience,
commitment to adoption,
etc.--may be sent
separately via email.)

Summer 2006 Workshop Application