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2. First Name*
3. Last Name*
5. Summer Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Home Phone Number
14. Cell Phone Number*
16. School Name*
17. School Phone Number*
19. School Address*
21. School City*
22. School State*
23. School Zip Code*
25. School Email Address*
26. Grade(s) and Subject(s) You Teach*
28. What are you hoping to gain from your participation in the Institute?*
30. E-Signature*

    If I am selected to participate in the West Baton Rouge Museum’s Teachers’ Institute, I agree to attend all days. I also agree to participate in all activities and to contribute my teaching ideas to the West Baton Rouge Museum by completing all project work for presentation and submission before departure in return for receiving the stipend and certificate. I understand that typing my name in the above box functions as both agreement and an online signature.

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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field