COSEE-SE: Centers for Ocean Sciences Educational Excellence

CONTACT INVENTORY

CONNECTION to COSEE SE If you participated in a COSEE SE event, please answer the following...

Event Title

Event Date

Location
City, State
Check your role:Participant Presenter Other

Contact Information: Your Name
Place of Work
Work Phone
Work Address
City, State, Zip
Email address (1)
Email address (2)
Home Address
City, State, Zip
Home/Cell Phone

Diversity Information Check the appropriate race and ethnicity you consider yourself to be.

American Indian or Alaska Native	White (not of Hispanic origin)
Asian	White (of Hispanic origin)
Black or African American	Other
Native Hawaiian or Other Pacific Islander

Profession Check the profession which best describes you.

Informal Education (aquarium, park)

Formal Education (K-university graduate)

State/Federal Government/Non-Profit Administrator

Business/Industry/Private Sector

Other

For Scientists/Researchers Are you a scientists and/or researcher? Yes No

Check the statement(s) that apply

I interact with K12, informal, and/or public education communities
I submit proposals and include a K12 or informal education component under broader impacts or outreach sections

For Educators/Teachers/Instructors/Teaching Faculty If you are in Formal Education, check the level which best describes your students?

K-5 (elementary)
6-8 (middle)
9-12 (secondary)
University/College (sciences)

If you are a K-12 educator, check the subject(s) you teach?

Sciences Language Arts Special Education Math
Media Coordinator Earth/Marine Science Social Studies

School Demographics Check the best description of your school setting

Rural Suburban Urban

Indicate the percent (%) diversity of the students you teach in your classes.

% American Indian or Alaska Native
% Asian
% Black or African American
% Native Hawaiian or Other Pacific Islander
% White (not of Hispanic origin)
% White (of Hispanic origin)
% Other

% TOTAL

Total number of students you teach per year