Registration Form
Whitehead Seminar Series for High School Teachers

Please return this completed form to Amy DiGangi, Whitehead Institute, Five Cambridge Center, 7th Floor, Cambridge, Massachusetts 02142 or fax to 617-258-8848. The deadline for registration is Friday, September 30, 2005. Space is limited; we will accept applicants on a first-come, first-serve basis. If you have questions, please contact Amy DiGangi at 617/258-7270 or via email at digangi@wi.mit.edu.

The series meets from October through June. Each session will consist of a lecture and a working dinner held on 10/11, 11/7, 12/5, 1/9, 2/6, 3/6, 4/3, 5/1, and 6/5 at 4:00 pm at Whitehead Institute’s McGovern Auditorium. Dinners are over by approximately 7:00 pm. Participants who miss more than three sessions will be dropped from the program.

______________________________________________________________________
Name

______________________________________________________________________
Home address (line 1)

______________________________________________________________________
Home address (line 2)

__________________________
Home phone

______________________________________________________________________
School

______________________________________________________________________
School address (line 1)

______________________________________________________________________
School address (line 2)

_________________________
School phone

_________________________
E-mail address

Please send seminar materials to:

_____ my home address.
_____ my school address.

Whitehead partner program:

_____I want to be assigned a Whitehead partner (please see below).
_____**I would like to be paired with the same partner as last year (please see below).
_____I DO NOT want to be assigned a Whitehead partner.

______________________________________________________________________

Whitehead Partners

As in previous years, we will match each teacher with a postdoctoral fellow, graduate student, or technician partner, who will serve as a resource for you throughout the year. So that we can match you with a partner who is able to meet your specific needs, please decide which level of partnership is most appropriate for you.

Check one:
_____ Minimum level of involvement: I would like my partner to attend the lecture and lab during each session and to join me for dinner. I expect that we will communicate occasionally by phone or by e-mail between sessions.

_____ Medium level of involvement: I would like my partner to attend the lecture and lab during each session and to join me for dinner. In addition, I would like to communicate with my partner often by phone or e-mail between sessions.

_____ Maximum level of involvement: I would like to be in frequent contact with my partner, during and between sessions. I would like to meet with him or her regularly (generally before or after the monthly sessions) so he or she can answer my questions. I would also like to bring my students to the Whitehead Institute to meet my partner or to have my partner visit my school.

**(We will do our best to accommodate this request, but cannot guarantee the same partner as last year.)

Last updated August 29, 2005..