Bridging the Watershed - Institute Registration

Institute Registration

Please fill in the following three-page form completely. Written support is requested from your school principal or the appropriate administrator who can approve a field study. In the appropriate field on page two of this application, please provide your principal's/administrator's name and email address, and we will forward an acknowledgement email indicating your desire to participate in Bridging the Watershed.

NOTE: Please complete the application in its entirety and in one session as information cannot be saved and continued later. The application should take approximately 15 minutes to complete. Please proofread each page carefully before you go on to the next as you cannot go back to a previous page.

I. General Information
Institute *
First Name *
Last Name *
Home Address *
City *
State *
Zip *
Phone (best one to be reached) *
Email (best one to be reached) *
How did you hear about Bridging the Watershed? (Check all that apply) *	Colleague Administrator Pamphlet/Brochure Website Live Event Other
Are you interested in earning MSDE credit? (Maryland teachers only) *	Yes No Maybe
Previous Environmental Science Background *