Name:

Home Address: Phone:

City: Zip:

E-mail Address:

Bachelor's Degree:
Institution: Major: Year:

Do you have a teaching certificate?

If your answer is YES, what level and content area? (if you have more than one certificate, list all certificates)
1st certificate: level content area:
2nd certificate: level content area:
3rd certificate: level content area:

Have you taught any of the following (with or without a certificate): Elementary, Middle School, or High School? If so, please list which ones.

Please list the college mathematics courses you have taken.

Please list which course(s) you would like to take. Each course meets on the UMC campus Monday through Friday for the indicated two-week period and is scheduled to meet 4 hours per day (10 AM to 12 noon and 1 PM to 3 PM). Taking any number of the four courses is allowed.

• Mathematics of Change (June 9 to June 20)
• Data Analysis and Probability (June 23 to July 3)
• Algebraic Structures and Number Theory (July 7 to July 18)
• Geometric Structures (July 21 to August 1)

Briefly explain why you are interested in taking the courses you have chosen.