The Last Survivor (10/4/12) Survey

To register for The Last Survivor: A Classroom Action Project and Resource Guide (October 4, 2012), please fill out the following information.

Please note: A limited number of spots are available to non-Chicago Public Schools educators for this workshop.

Cost: $15 due at time of registration
Time: 4:30 - 7:30 p.m.
Location: University Center, 525 S. State Street, Chicago

Seating is limited and will be filled on a first-come, first-served basis. Maximum two teachers per school per workshop.

Attendance will be confirmed via email within 3-5 business days. Confirmed participants will also receive a reminder email the week of the workshop with more details.

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1. Basic Information

Basic Information First Name
Last Name
Email Address
School Name
School Address
School City
State
Zip
School District
School County
Phone Number (Primary)
Grade Level(s)
Subject

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2. Have you visited IHMEC before? Please choose all that apply.

Have you visited IHMEC before? Please choose all that apply. Yes, for an Open House

Yes, for a teacher training or Summer Institute

Yes, for a field trip

No, I have never been to IHMEC before

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3. How did you hear about this teacher training?

How did you hear about this teacher training? Email

Website

Colleague

Program Booklet

Other, please specify

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4. Would you be interested in learning more about our educational opportunities?

Would you be interested in learning more about our educational opportunities? Yes

No