SUMMER AGRICULTURE INSTITUTE 2011 Application Form Session Dates: (Select First Choice) Session #1 ____ June 19th - 24th Corvallis Session #2 ____ July 17th – 22nd Union/La Grande
Name_____________________________________________________________ Hm. Address___________________________ City____________________ Phone ___________________________ Email Address_______________________________________________________ Male______ Female______ Birth Date (mm/date/year)_____________ OSU Student ID (if known)____________
*Current Teaching Position: School: ____________________________ Ph.#________________________ Grade Level: _______________________
Zip___________
District/Locations: ________________________ ________________________________ Subject(s) Taught: _______________________ ________________________________
Prior Teaching Experience: School(s): ____________________________ District/Location _________________________ ______________________________ _________________________ Grade Level(s): ________________________________________________________________ Subject(s) Taught:_______________________________________________________________ # Of Years/Dates: _______________________________________________________________ List previous Agriculture experience(s), if any. Education: _____________________________________________________________________ Hands-On: _____________________________________________________________________ Practical/Work Experiences: _______________________________________________________ Personal Experiences: ____________________________________________________________ Describe ‘briefly’ your definition of Agriculture. ______________________________________________________________________________ ______________________________________________________________________________________
How did you find out about SAI? ________________________________________________________
Summer Agriculture Institute (SAI) is a project supported by the Oregon Agricultural Education Foundation. Participants receive 3 graduate level credits, AED 518, through Oregon State University. A $500.00 registration fee per participant is required (Non-refundable after May 1st). Fee includes OSU tuition, hotel accommodations, meals, and transportation for the weeklong activities; and curriculum, resources, and classroom kits. Space is limited in both sessions, apply early! Please return application along with the registration fee to: Oregon Agricultural Education Foundation 3415 Commercial St SE Salem OR 97302 *Agricultural Science and Technology teachers not eligible for SAI. The Oregon Agricultural Education Foundation utilizes SAI to introduce agriculture to teachers with little or no agricultural experience. Contact Information / Additional Applications: Debbie Crocker, Session #1 Coordinator, Corvallis, (541) 740-5073, email: dcrocker@99webstreet.com Jana Lee Dick, Session #2 Coordinator, La Grande/Union, (541) 562-5129 email: jana.dick@oregonstate.edu