Your Name:

Your Email:

Title
MsMrsMrDrOther

Pronouns
she/herhe/himthey/themshe/theyhe/theyany pronounsOther

Educational Setting
Public SchoolPrivate SchoolCharter SchoolMuseumHomeschoolOther

District

School name

Learning Community Brief Description (if not teaching in a school)

City/Town

State

The community where you teach could best be described as:
UrbanSuburbanRuralOther

Years of Experience in Your Educational Field:
1-56-1010 or more

Grade Level You Teach (Currently)* and How Many Students do teach per year?

The following questions allow our NEH Landmarks team to get to know you and your intentions for participation in this summer institute.
Which content areas or disciplines do you teach/have you taught, and what experience do you have (if any) with place-based learning? (250 words or less) *

What motivates your participation in this specific NEH Landmarks summer institute and what do you think it might contribute to your teaching? (250 words or less) *

Have you ever attended an NEH Landmarks summer institute before? If yes, which one?

How did you learn about this program?

The institute runs twice in July: June 16-20 and June 23-27. You must attend the entire week. Please let us know your availability.
I can only attend the week of June 16I can only attend the week of June 23I prefer the week of June 16I prefer the week of June 23either/no preference

I understand my attendance is required for the full week and that if I do not attend for the full week I will not be eligible for the full stipend.
I acknowledge