Print, Fill out and Fax to Dr. Richard Peterson, NCSU FAX 919/515-6892

Before May 1, 2005

TECH-know Application for Summer Workshop

North Carolina State University, Raleigh, NC - July 17-22, 2005 - FAX 919/515-6892

Name: _______________________________________________________________________

Home Address: _______________________________________________________________

_____________________________________________________________________________

Home Email Address: _______________________ Home Phone Number: ________________

School Name: ____________________________ Principal’s Name: _____________________

School Address: _______________________________________________________________

_____________________________________________________________________________

School Email Address: ________________________ School Phone Number: _____________

Class Size: ________________________ Type of School: Rural Suburban Urban

Teaching Responsibilities/Class Name: _____________________________________________

Grade Level: _____________Number of Years Teaching: ________ TSA Advisor: Yes No

Based on your teaching expertise and grade levels (Middle and/or High School), please rank the order

your preferences 1-10 on the following Tech-know Units with [1] being your first and [10] being your

last choice. Unit descriptions and equipment requirements are listed at http://www.ncsu.edu/techknow/units.html

Middle School Unit Name	Rankings	High School Unit Name	Rankings
Agricultural and Biotechnologies		Agricultural and Biotechnologies
Cyberspace Pursuit		Desktop Publishing
Digital Photography		Film Technology
Dragster Design		Manufacturing Prototype
Environmental Challenge		Medical Technology
Flight Challenge		Robotics RC
Mechanical Challenge		Sci Vis
Medical Technologies		Structural Engineering
Structural Challenge		System Control
Transportation Challenge		Technology Challenge

Comments: