Microcomputer Based Laboratories (MBL) Workshop

Vernier Software and Technology,

Beaverton, Oregon

Administrator Follow-Up Form

(Please print information)

 

Following the workshop it is our intent to send a letter of appreciation to one or two administrators at your high school or college.

 

Please print or type all information clearly and exactly as it should appear.

 

Your Name [title first (middle) last]                

            _____________________________________________

 

Department                              ________________________________________________

 

College/High School               ________________________________________________

 

Address                                   ________________________________________________

 

City, State ZIP                       ________________________________________________

 

 

Chief College/High School Administrator

 

Name [title first (middle) last]

________________________________________________

 

Position                                   ________________________________________________

 

College/High School               ________________________________________________

 

Address                                   ________________________________________________

 

City, State ZIP                       ________________________________________________

 

 

Other Administrator

 

Name [title first (middle) last]

________________________________________________

 

Position                                   ________________________________________________

 

College/High School              ________________________________________________

 

Address                                   ________________________________________________

 

City, State ZIP                       ________________________________________________

 

 

Please submit this completed form to Curtis Hieggelke or Tom O’Kuma at the workshop in Beaverton, Oregon or

 

send it to the Physics Workshops For The 21st Century Project Office, Joliet Junior College, Natural Science Department, 1215 Houbolt Road, Joliet, IL 60431-8938.