Entry Form

Thank you for your interest in the Teacher Challenge.  Please fill out the following information and return it to the address given below.  An e-mail confirmation will be sent when your complete entry is received.  If you have questions, please visit www.TeacherChallenge.org or e-mail Support@TeacherChallenge.org.

Participant Criteria:

Educators must teach in a K-12 school, museum, science center, or other informal venue that is located in one of the regions indicated below.

Competition Deadlines:

Region you are applying for (select one R):

        Long Island, NY (Nassau, Suffolk, Queens)

        Essex County, NJ

        Virginia

Educator’s Name: _____________________________________________________________________

District: __________________________________   School: ___________________________________

Institution Name (if not a school): _________________________________________________________

Address: _________________________________   City: ___________________________ZIP: _______

E-mail: ___________________________________   Work Phone: (____)_________________________

Phone number where you can be reached directly: (____)_____________________________________

How did you hear about the Teacher Challenge? ____________________________________________

Entrant’s Signature: ______________________________________

Entry Checklist:

        Entry Form

Printed or digital copy on CD of your lesson plan

Letter of recommendation on institution letter head from your supervisor/administrator

Mail to:

CSTL, Attn: Teacher Challenge

1 Tanglewood Rd., Rockville Centre N.Y. 11570.