1. Full Name              2. Date of Birth   

3. Postal Address          4. Post Code

5. Preferred Phone Contact No.          6. Preferred Email Address

7. List of academic qualifications and years gained (certified copies will be required if you are short listed)

8. Previous teaching experience (List classes and years taught)

9. Position in school/scientific institute (eg Head of Science, Classroom Teacher, etc)

10. Basic medical advice (This will not preclude you, but to give the SBA team of any pre-existing conditions/ailments that will be required for planning purposes)

11. Please list any dietary requirements and/or food allergies

12. List professional and educational association membership (including time involved and any active roles)

13. Describe any conferences or education based events that you have been involved in organising and in what capacity.

14. Discuss other clubs and associations that you may be involved with.

Answering specific criteria in relation to the objectives of Spaceward Bound, for each category you will need to write 100-250 words regarding each:

A. Describe your past commitment to Earth, planetary and/or space science within your classroom or organisation

B. State your previous attendance at any relevant professional development.

C. Describe your Teaching practices/methodologies. Outline a teaching style or a specific classroom approach that you have used to maximise student growth, development or curriculum implementation?

D. What programmes, initiatives related to SBA programmes have you assisted in implementing at the school, district or association level

E. How do you feel programmes in SBA are going to enhance your teaching programmes?

F. Describe some areas within Spaceward Bound that interest you or that you would like to research?

G. If you attend SBA how do you intend to disseminate the information relating to SBA?

You understand that by completing this application and if you are successful, that you will be joining Mars Society Australia, Inc (Or renewing as a current member) and attending AMEC2009 following SBA.
You will be committing to professional development and providing this professional development for other educators relating to your experiences. You also agree that materials that you will be developing as a participant on SBA will be shared with other educators with no cost for those materials as per MSA regulations.
You also understand that your costs of flying to Adelaide for AMEC 09 and costs to attend AMEC 09 will be self-funded with MSA/NASA partly funding accommodation, food and transport from Adelaide to Woomera/Arkaroola and return.

I acknowledge my requirements as a potential attendee on SBA2009 by completing and sending this email.

Name    Dated    When ready: