University of Saint Mary Teacher Workshop Prospective Leaders

First Name

Last Name

State:

Email Address

Phone:

Have you taught a workshop for Saint Mary in the Past?

If yes, Please list the USM workshops ( or workshop topics) you've taught.

For what school district are you currently employed?

Which of the following best describes your current teahing level?

Highest level of education?

Bachelors

Masters

Terminal (PhD, EdD)

If :"other", plese descibe

Areas of expertise:

In what areas are you currently endorse to teach in? (KSDE Teaching License)

What types of workshops are you interested in facilitating?

Are you intrested in teaching workships on-site in your districtg, or on-ground at USM ( Plese check all that apply.)

At my district

At USM's Overland Park Campus

At USM's Leavenworth Campus

When would you be interested in leading a workshop? ( Check all that apply)

Fall

Spring

Summer

ANy additional informatiion you'd like to share?