NOAA'sTeacher at Sea Form A: Participant's Application

NOAA’s Teacher at Sea Program Form A: Participant's Application
OMB Control #0648-0283; Expires 6/30/2010

Name:_______________________________________________________________________________
Date of Application:_____________________________________________________________________
Home Address 1:_______________________________________________________________________
Home Address 2:_______________________________________________________________________
City:______________________________________State:______________Zip:_____________________
Home Phone:_____________________________ Cell Phone:___________________________________
Name of School:_______________________________________________________________________
School Address 1:______________________________________________________________________
School Address 2:______________________________________________________________________
City:______________________________________State:______________Zip:_____________________
Work Phone:____________________________ Citizenship:____________________________________
Sex:

Female

Age:

21-29

Male
30-39

40-49

Have you applied previously?

No

50-59
Yes

60-69

70-79

80-89

90-99

Over 99

If yes, please list all years:__________________________

E-mail (required for notification):__________________________________________________________
What subjects and grades do you currently teach?
_____________________________________________________________________________________
_____________________________________________________________________________________
What subjects and grades are you likely to teach next year?
_____________________________________________________________________________________
_____________________________________________________________________________________
What leadership roles have you held in education?
_____________________________________________________________________________________
_____________________________________________________________________________________
On a separate piece of paper attached to this application, please address the following:
1. NOAA's primary interest in this program is the way in which teachers will incorporate the experience into
their classroom activities and help others do the same. How will you use this experience to benefit your
students and colleagues? (Note: This is the most important selection criteria.)
2. Describe your experience with and ability writing your own classroom activities. Please be specific and
offer examples.
3. What type of project would you prefer to join? Please explain the reasoning behind your choice.
4. Discuss your ability to adapt to the physical and personal demands of life onboard a ship.

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NOAA’s Teacher at Sea Program Form A: Participant's Application
OMB Control #0648-0283; Expires 6/30/2010

Due to homeland security concerns, NOAA ship schedules are no longer available to the public; therefore
you cannot select a cruise specifically. By filling in the following parameters, you will be matched with a
cruise that best fits your interests. Since placement is based upon ships’ bunk space availability, the more
flexible you are, the more likely you will be placed. If you are flexible, respond to the question with “N/A.”
However, you must list the exact dates of your availability.
A) Please list below ALL the dates that you would be available to participate on a cruise. Available Dates:
_____________________________________________________________________________________
_____________________________________________________________________________________
B) Nature of the research conducted that you are most interested in:
_____________________________________________________________________________________
_____________________________________________________________________________________
C) Do you have a preference as to where the ship operates? Preferred Ports/Area:
_____________________________________________________________________________________
_____________________________________________________________________________________
D) How long are you comfortable being away at sea? Some cruises last over a month. Preferred length of
cruise:
_____________________________________________________________________________________
_____________________________________________________________________________________
Completed application packets must be postmarked by December 31, 2009.
SEND COMPLETED APPLICATIONS TO: NOAA’s Teacher at Sea Program, 1315 East West Hwy,
Division F/Room 14249, Silver Spring, MD 20910. Include Form D with Form A, and Forms B and C
in their sealed envelopes.
Selection and Notification
Applications will be reviewed by the NOAA Teacher at Sea Selection Committee. After review, applicants
will be notified via e-mail of the Committee’s selections.
Participant placements will be made approximately 1 to 2 months prior to the sailing date.

PAPERWORK REDUCTION ACT INFORMATION
NOAA conducts the Teacher at Sea Program in order to promote oceanographic and related education. The information obtained from the
application will be used to select the teachers who will be accepted for participation in the program, and an application is required for
acceptance. The information submitted on this form will not be treated confidentially. Public reporting burden for this collection of information
is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to NOAA’s Teacher at Sea Program, 1315
East West Hwy, Division F, Silver Spring, MD 20910
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to
comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection displays a
currently valid OMB Control Number.

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