Teacher Information Sheet

Teacher Name *

Room Number *

Year *

Email Address *

Phone Number *

Extension

School Name *

Street Address *

City *

State *

Zip Code *

Have you used Science in Motion before? *

Yes

What time do you usually arrive at school? *

Will you be able to arrive earlier, if necessary? *

Yes

Class Schedule (Please include all of your classes, even if you don't think SIM will service them all. Include prep and lunch periods as well.) *

		Number of Students Per Grade Level
Time	Course	7	8	9	10	11	12
1 —
2 —
3 —
4 —
5 —
6 —
7 —
8 —
9 —

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514 University Avenue

Selinsgrove, PA, 17870 United States