International Education Washington

Thank you for your interest in registering for the 2009 Capitol Forum on America's Future.

Logo of the Washington State Capitol Forum

To register, please complete the form below. Thanks!

Tip: You may find it helpful to draft your responses to the questions below
in Word first, then copy and paste them into this form.

Step 1: Register for the Capitol Forum. (check the one that applies)

   I am definitely interested in participating in the Capitol Forum. I understand that
        the cost per team is $100 and I will need agreement from my principal to take time
        off to attend the Capitol Forum in Olympia in March 26, 2009.

I am possibly interested. Please send me more information.

I cannot participate this year, but contact me about a future year.

Note: All registrations are contingent on space available and receipt of payment. We will send you a confirmation as soon as we know for sure that we can accept your registration.

Step 2: Provide Teacher Contact Information

Teacher First Name
Middle Name		(optional)
Last Name
School Name
School Email
Personal Email
Your Role or Title
School Address
City
State/Province
Zip/Postal Code
Home Address
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
Mobile Phone

How do you prefer to be contacted? At home At school Either

Please list the courses you teach, indicating the grade levels:

Step 3: Provide Educator—School Profile

Note: If you are a returning teacher, you do not need to complete the School Profile.

Applications will be judged on the quality of responses. In addition, this program seeks to include schools representative of the diversity of communities that exist within the state.

1. Please provide us with a brief “snapshot profile” of your school. What are its strengths, challenges, or defining characteristics?

2. How many years have you been teaching? How would you describe your style of teaching?

3. Describe the class(es) that will participate in the preparation exercises for the forum and the balloting, and from which you will select the four-five students to attend the Capitol Forum on America’s Future.
(Please indicate the total number of students who will be involved.)

4. Why have you applied to participate in this program? How will this program address your curricular objectives and goals for students?

Step 4: What questions do you have?

Let us know if you have any specific questions or comments about the Washington State Capitol Forum on America's Future.

Or for more information, contact the Washington State organizers:
Michele Anciaux Aoki michele.aoki@k12.wa.us (360) 725-6129.

Click Submit to send us your information or Reset to display a blank form. After clicking Submit, you will see a confirmation page display.

Thanks for your commitment to International Education in Washington State!

Capitol Forum Registration Form