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Lead Adult Facilitator: |
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| School/Organization Name: |
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| School/Organization Address: |
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| School/Organization City/State: |
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| School/Organization Zip/Postal Code: |
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School/Organization Phone: |
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| School/Organization Fax Number: |
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| Lead Adult Facilitator's Email Address: |
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What type of student group do you envision for your team participation in
MSIP? (i.e. classroom, entire grade level, entire school, science club,
study group, etc.)? Please include an approximate number of students on your
team.
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| Please check the formats for the activities in which you are
interested in participating: |
On-Site Format
Distance-learning Format
Archived-data Format |
MSIP training will be conducted year-round. If your MSIP team is interested
in the on-site or distance-learning formats and there are particular dates
that may be convenient for participation, please indicate these dates.
These dates will get finalized as the MSIP requirements are being met.
It is not required to fill in these dates on this application.
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For our information, please indicate a possible month/date in which you feel
you may begin working with the Mars Student Imaging Project curriculum.
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Please write a brief description as to why your team is interested in being
involved in the Mars Student Imaging Project:
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I hereby acknowledge that I am applying to be involved in the Mars Student
Imaging Project — a project that allows for real Mars exploration for
students in the 5th-12th grades. I understand the procedures necessary in
order to fully participate in this project (submission of application and
model activity results form), before I can submit a Mars Participating
Science Team Proposal. I realize that the team of students that will
work on this project will need to be committed, dedicated students who will
help NASA explore the Red Planet. By entering my name below, I acknowledge
this statement. |
| Lead Educator: |
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| Date: |
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| Grade Level of MSIP Team: |
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| Total Number of Students Participating: |
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Optional Information: |
| Type of setting that best describes your school: |
Rural
Inner City
Other |
| Approximate number of female students on your team: |
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| Approximate number of minority students on your team: |
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