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Eplus
Multipage
Step
1
of
4
Applicant info
First Name
*
Last Name
*
Email
*
Street Address
*
City
*
Province/State
*
Postal/Zip Code
*
Country
*
Home Phone
*
Mobile Phone
*
Gender (for accommodation purposes)
*
male
female
1. How did you hear about Eplus?
*
EinsteinPlus Alumni
PI website
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Teachers/Colleagues
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1
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4
Step
2
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4
Teaching Qualifications
2. How many years have you been teaching?
*
3. How many years have you been teaching Modern Physics?
*
4. Please provide an example of good pedagogical approach you use in your Physics Classroom
*
5. Please Provide Evidence of educational leadership that you have demonstrated
*
such as presentations at or coordination of workshops, colloquial, conferences etc
6. Professional affiliations and memberships in professional associations
2
/
4
Step
3
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4
School Information
School Board/District
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School Name
Principal Name
Street Address
Province/State & Country
Postal/Zipcode
School Phone Number
3
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4
Step
4
of
4
Statement of Interest
7. Please specify what you hope to gain from participating in eplus?
4
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4
