Student Network Administration Project Teacher Application Form

Please type or print:

1.  Teacher Name:   ________________________________________________________________ 
			Last			First	           Middle Initial

    Title (please circle one):	Mr. / Ms. / Mrs. / Dr.

2.  Home Mailing Address:   ________________________________________________________

			    ________________________________________________________

    Home Phone:	(_____)	___________________ Home Fax:   (_____) ____________________

    email address:  ________________________________________________________________

3.  School Name:    ________________________________________________________________

    Mailing Address: _______________________________________________________________

    School Phone: (____) __________________ School Fax: (_____) ____________________

    URL for school web page:	____________________________________________________

4.  Please check the category that applies to you:

    Personal Internet access:
	at home:    none_________	text-only__________     graphics__________
	at school:  none_________	text_only__________     graphics__________

	Location(s) at school:	classroom_________	office__________
	(check all that apply)	computer lab_________	media center__________

    Student computer access at school:
	Number of student-use computers in your classroom:__________
	Do these computers have Internet access?__________
	Computer type (e.g. Apple IIe, Mac SE, PowerMac, PC/386, PC/486, etc.)

	    ________________________________________________________________________
        Computers available for student use elsewhere in the school:
	    Location(s):	computer lab_________	media center_________
	    (check all that apply)  other (please describe)_________________________
	Do you or are you able to take your classes to one of these locations for 
	    computer-related work?  (please elaborate)

	    ________________________________________________________________________


___

The following questions should be answered as completely as possible.  Please
use a separate sheet of paper for your responses.

5.  Please describe your computer experience.  Include your experiences as a student,
    as a teacher, and in any other context.

6.  Please describe how you will be able to test this new curriculum with your
    students during the 1998-1999 school year.