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Teacher Information Sheet

Please complete the form below to submit your teacher information on-line. You can also download the form in Adobe Acrobat format here if you prefer to complete and mail a hard copy of your information.

Fields marked in red are required fields.

Name:
School:
Room Number:
Year:
E-mail:
Phone:
EXT

School Mailing Address:
Street:
Town:
State:
Zip Code:

Have you used Science in Motion before?


Please fill out the table below with your schedule for this year. Include the times of the periods, title of the course, and the number of students in each grade level for each period. Please put all your classes down, even if you don’t think SIM will service all of them. Include prep and lunch periods as well.


What time do you usually arrive at school?

am pm
Will you be able to arrive earlier, if necessary?


You MUST enter at least one class.

Class
Time
Course
7
8
9
10
11
12
1
to
2
to
3
to
4
to
5
to
6
to
7
to
8
to
9
to

 

 

Susquehanna University Last updated by Melanie Rohrbach
Courtney Thomas, Director, Science in Motion
©2002 Susquehanna University, Selinsgrove, PA 17870
Telephone: 570-372-4779 Fax: 570-372-2791