Bridging the Watershed - Institute Registration

2011 Educator Career Awareness Institute Registration

July 11-15: National Conservation Training Center, Shepardstown, WV **FULL**

August 15-19: DC Booth Fish Hatchery, Spearfish, SD

Please fill in the following form completely. This is only the application. Travel arrangements will be made separately.

I. General Information
Institute *
Name *
Home Address *
Home Address 2 *
Home Phone *
Cell Phone
Email *
Years of Teaching/School Counseling/Administration Experience *
Highest Degree Held *
Discipline *
Previous Experience with Department of Interior * Previous Experience with Career Advising *
II. School Information
School *
School Address *
School Address 2 *
School Phone *
County *
School (check one) *	PublicPrivate
What do you plan to apply for? (Check all that apply) *	Graduate Credit Local Continuing Education Credit None
T-Shirt Size *	Small Medium Large XLarge XXLarge

Alice Ferguson Foundation
2001 Bryan Point Road, Accokeek, Maryland 20607
btwinquiriesl@fergusonfoundation.org