Home Address________________________________________Phone_____________________


E-mail address__________________________________________________________________

Bachelor's Degree: Institution_______________________Major_________________Year______

Do you have a teaching certificate? __________Yes__________No

If your answer is yes, what area?______________________what grade level?_______________

Have you taught any of the following (with or without a certificate)? (check all that apply)

__________Elementary School
__________Middle School
__________High School

List the college mathematics classes you have taken:






Check 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.

__________Data Analysis and Probability (June 11 to June 21)

__________Algebra (June 24 to July 5)

__________Geometry (July 8 to July 19)

__________Mathematics of Change (Calculus) (July 22 to August 2)

Please send your completed form to Professor Ira Papick, Mathematics Department, University of Missouri-Columbia, Columbia, MO 65211.


Deadline: Please submit application by March 31, 2002.

Admittance: Notification will be sent out by April 15, 2002.