Teacher Inservices

Please submit a completed application at least three months in advance of event.

Fields marked with * are required.

Application Date*	Date of Event*	Length of Program (hrs)*

School Name*	School Address*	City*

State*	Zip*	County*

Contact Person*	Home Phone (include area code)	School Phone (include area code)*

Email*	Have you ever attended a TMA in-service or workshop?
	Yes No
If so, please provide the theme/title of the workshop and the year in which it was held.	What is the overarching goal or theme for your in-service? (e.g. art & science)	Is there a particular gallery or special exhibition that you would like to view?

If you have any special requests for the agenda (e.g. time for a staff meeting), please list the activities and appropriate time needed for each.*

How many teachers will be attending?*	What disciplines do they teach?*

Would you like a hands-on component?	Would you like a catered meal?*
Yes No	Yes No

Please enter the characters you see into the box below

Need more information? Contact the Resource Center at (419) 254-5076.