First name *

Last name *

Email *

Email (Confirmation) *

Home address *

Phone number where you can be reached now and during the summer *

How do you identify? *
Currently teaching
Pre-service teacher
Informal educator
Administrator

Which grade(s) are you currently teaching or plan to teach?

What school do you work at? *

What university do you attend? *

What organization do you work for? *

Are you applying for SCECHs? (Fees will be paid by the RMSC) *
- Select Option Yes No

Personal Identification Code (PIC) *

CODE OF CONDUCT
GVSU strives to provide the highest quality program in a safe environment for every participant. Please assist us in maintaining a safe and enjoyable environment.
Participants should be positive role models for minors and act in a responsible manner. It is expected that all participants adhere to the below expectations.
1. Do not be alone with a minor.
2. Profanity, vulgarity, or harassing language is prohibited.
3. Participants are expected to adhere to University policies, including but not limited to those policies concerning alcohol and drug use, personal conduct, sexual harassment,
diversity, and non-discrimination.

ASSUMPTION OF RISK
There may be certain risks inherent in being on campus. The instrucotr will review all rules and safety guidelines for participation in this activity. I understand that I am required to follow the rules and safety guidelines. In addition, as a participant in this activity through Grand Valley State University, I the undersigned, in full recognition and appreciation of the dangers and inherent hazards to which I may be exposed during my participation in this program, do hereby agree to assume all the risks and responsibilities surrounding my participation in Engineering is Elementary professional learning or any independent activities undertaken as an adjunct thereto. I understand and agree that the University, its officers, agents or employees are granted permission to authorize emergency medical treatment, if necessary, and that such action shall be subject to the terms of this Agreement. I know that as a participant, I am personally responsible for the expense of any medical care received for injuries incurred. I understand and agree that the University, its officers, agents or employees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.