2000 CHEMISTRY VAN PROGRAM
for
HIGH SCHOOL CHEMISTRY TEACHERS

CHEMISTRY VAN APPLICATION

Please answer the following questions about yourself:

• Name

• Home Address

• City

• State:

• Zip:

• Are you certified in Chemistry?

• Are you certified in anything else? List certifications.

• Number and type of chemistry courses currently taught (ie, regular, honors, AP)

• Number of students you teach chemistry to each week?

• Do any of your students participate in science fairs? How many last year?

• Have you participated in other workshops and inservices? (list places, types and dates)

• How do you think that the chemistry van can help your school?

  Answer the following questions with YES or NO.

  (Please note that these questions are used to help us assess the logistics of serving your school and will not penalize your application in any way)

• Our school has at least one chemistry laboratory
  If the answer to this question is yes then please answer the following:
• At least one lab has functioning electrical outlets.

• At least one lab has functioning water lines

• At least one lab has functioning gas lines

• At least one lab has functioning hoods

  Please use short answers for the following questions:

• What floor is the chemistry lab(s) on?

• Do you have elevators in your school?

• Is there a safe place to part a vehicle all day?

• Are ramps available to wheel carts up stairs both inside and outside school?

• Do you have a chemical storage room?

• How many times each year do you conduct a lab experiment with your class?

• What lab book do you use?

• What chemistry textbook do you use (list title, author and edition)?

• What kind of chemical equipment do you have?

• Application Deadline: Friday June 2, 2000
  To submit the application:

  By US mail, use your browers print button to print out the application and send it to the address below, or the application and answers can be sent to the the email link below.

  Dr. Michael N. Mimnaugh, Chairman
  Dept. of Chemistry and Physics
  Chicago State University
  9501 S. King Drive
  Chicago, IL 60628
  Phone: 312-995-2180, Fax: 312-995-3809
  email