Sponsor: NC Space Grant
Program: NC Space Education Ambassadors (NCSEA)
Personal Information
| First Name: | |
| Last Name: | |
| e-mail: | sample-applicant@example.com |
| Alternate e-mail: | |
| Address: | |
| CityState , - ZIP Code +4 Lookup ZipcodeZipcode +4 | |
| Congressional District: |
To find your Congressional District visit the House of Representatives Website. If your permanent home address is out of state please choose the congressional district for your school. |
| U.S. Citizenship/Residency: |
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References
Each participant must be recommended by a school administrator who is willing to verify that the candidate: A) is someone who has the potential to be a leader among teaching peers; B) will have a
viable opportunity and the necessary school system support to offer one or more space science-related professional development workshops to local and/or regional colleagues;
C) will support the release time for the NC Space Education Ambassador to attend the professional development at NASA Langley and the Bridging the Gap Conference.
Please give the name (and email) of the school administrator who will be writing you a recommendation.
| Principal/Administrator | |
| Name: | |
| Title: | |
| Phone: | |
| email: | |
| email confirm: |
Professional Information
| Grades You Currently Teach: | |
| Subjects You Currently Teach: | |
| Your Current Position/Title: | |
| School: | |
| Address: | Address Line 2 |
| City: | |
| State and Zipcode: | State Zipcode |
| Phone: | |
| Fax: | |
| School email: | |
| School District: | |
| School Type (check all that apply): |
Professional Experience
What is your formal education and teaching experience? (degree, years taught, etc.) (250 word limit)
What is your current assignment? (Describe job responsibilities and other related duties) (500 word limit)
List professional activities. (In-service participation, membership in professional organizations, number of workshops taught and audience (500 word limit)
(500 word limit)
Essay Questions
Tell your school story including demographics of the student population and community. (500 word limit)
Describe a meaningful STEM learning experience your students have engaged in that impacted your school and community. (500 word limit)
Explain how you will engage other educators and organizations if selected as a NC Space Education Ambassador? (500 word limit)
How would participating in the NC Space Education Ambassadors Program impact you and the educators in your school, district and region? How will this program impact you as a leader within your school district and region? (500 word limit)
Optional Information
for reporting purposes only
| Gender: | Male Female |
| Ethnicity: | |
| Race: |
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| Birthdate: | |
| Person With Disability: |
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| Birthdate: | |
How did you hear about the NC Space Education Ambassadors (NCSEA)? |
Certification
If I receive this award I will:
- Participate in webinars, including a series of NASA professional development modules. These virtual experiences will be led by NASA Educational Specialists from various NASA centers via virtual platforms. 1-2 webinar sessions will be hosted per month (September 2023 through May 2024) on Tuesdays from 6:00-7:00 pm
- Complete lessons that compliment NASA content and share best practices during webinar sessions.
- Complete two dissemination activities in their respective districts to include: (1) one NASA professional development workshop, and (2) one NASA STEM Engagement opportunity for students.
- Attend a group field trip to NASA Langley Research Center in June 2024 (schedule dependent upon NASA Langley availability). NC Space Grant will cover all travel expenses.