WA-STATE APPLICATION : NWMI Middle Grades Program 2004
Print out this application, fill in all items, and send it with your payment
to the address below.
Name ______________________________________________
Home Address _______________________________________
____________________________________________________
Housing on campus? Check one. Yes _______ No ________
(Three nights included - M, Tu, W)
Your School __________________________________________
School Address _______________________________________
_____________________________________________________
Phones: Home (______) ________________ Work (______) ________________ Fax
(______) ________________
Email ________________________________________
Signature ____________________________________
Please include a check or PO payable to Dept.of Math, University of Washington.
OUT-OF-STATE teachers use OS form.
| Middle Grades Program |
(until June 15) |
(after June 15) |
| Teach in Seattle Public Schools |
$0 |
$0 |
| Teach in Washington State |
$250 |
$275 |
| Mail to: |
NWMI
University of Washington
Department of Math
Box 354350
Seattle, WA 98195-4350 |
Phone:
(206) 543-1915 |
Fax:
(206) 543-0397 |
Email: nwmi@math.washington.edu
Web page: http://www.math.washington.edu/~nwmi