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American Bar Association
ABA Division for Public Education

2011 National Online Youth Summit Application

Please complete all required fields (marked with a ).
Fields designated as "other" or "optional" may be left blank. Incomplete applications will not be considered.

Teacher Information

 Name


 Title


 Primary e-mail address


 Secondary e-mail address


 Home Telephone (with area code)


School Information (Note: Only high schools are eligible to apply.)

 School


 Principal's full name


 Department chair's full name


 Address


 City


 State


 Zip


 Telephone (w/area code)


 Fax


Website (opt)
http://

 School Setting



Is your school?

 Public


 Private


 Home School

Class Information

 Class name

Please enter the name of the participating class(es) below.

 Grade level

 Class duration

One quarter   Two quarters   Semester   Year-long

If this is a one-quarter class, which quarter?
1st   2nd   3rd   4th

If this is a two-quarter class, which quarters?
1st   2nd   3rd   4th

If you are on a Quarter system, please provide the start and end dates for each quarter below. (Ex. November 18)

1st Quarter Starts  Ends 
2nd Quarter Starts  Ends 
3rd Quarter Starts  Ends 
4th Quarter Starts  Ends 

If you are on a semester system, please provide the start and end dates for each semester below. (Ex. November 19)

Fall 2010 Semester Starts  Ends 
Spring 2011 Semester Starts  Ends 

 Breaks
Please provide Start and End Month/Dates for spring and winter breaks in the area below. (Only hit "Enter" if you are starting a new line.)


  What percentage of students in this class speak English as a second language?
%

What is the primary language, other than English, spoken by students in your class as their first language?

 Is this an honors or advanced placement class?
Yes   No

 Is this a basic skills or low ability class?
Yes   No

 Is this a required or elective class?
Required   Elective

 What percentage of students enrolled in the class do you estimate will have access to the Internet from home?
%

 Will students in this class be required to take any standardized test during your class period between January-May 2011?
Yes
No

If yes, when?


Teaching Experience

 Number of years teaching

 Have you participated in the Summit in the past?

Yes
No

If yes, when?

 Please explain the student learning objectives that you will seek to meet by participating in the National Online Youth Summit, Itís the Law: Guarding the Nationís Health.

 Please explain how you plan to integrate the Summit and the topic into your course.


  How did you learn about the National Online Youth Summit?

ABA Division for Public Education website

Colleague / Friend

NCSS Annual Meeting

E-mail notification (Source of e-mail)


Advertisement (Name of Publication)


Other (Please specify)


Please submit a signed letter of support by fax, e-mail (as a PDF), or mail.

Letters of support should be sent to the attention of:

Rina Shah
On behalf of the ABA
Division for Public Education
321 N. Clark Street, Mail Stop 20.2
Chicago, IL 60654-7598
E-mail: rshah.noys@gmail.com
Fax: 312-988-5494

Applications, including the letter of support, must be submitted no later than December 7, 2010.
Questions should be directed to Rina Shah at the above address, by phone at 703-651-6670, or by e-mail at rshah.noys@gmail.com.
NOTE: If, after sending your application, you get an error page asking you to fill in required fields that were left blank, use the link that says "Back" at the bottom of the page. (If you hit the back button in your browser, you may lose all of your work and need to fill in the entire application again.)

Before you submit your application, please review the entire form to be sure the information you are submitting is accurate.

I have reviewed the Participant Expectations and Technology Requirements, and I agree to fulfill them if accepted.

Agree

Decline

 

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