Form PTO/MTIP/001 MTIP Application

National Summer Teacher Institute

0651-0077 PTO-MTIP-001 Application 2023

MTIP Application

OMB: 0651-0077

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  1. MTIP application form


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PTO/NSTI/001
OMB Control No. 0651-0077
Expiration Date: 08/31/2024

Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

All fields are required to complete the Master Teacher in Intellectual Property (MTIP) application. For more information, please see the PRA Statement of Burden.

Your Information

1. First name:
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2. Last name:
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3. Street:
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4. City:
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5. State or U.S. territory:
                                                                                                                                                                                                                                                                                                                                                                                                                    
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State Selector

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6. Zip code:
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7. Telephone (where you can be reached this summer):
Shape8  (xxx-xxx-xxxx)

8. E-mail address (that you have access to this summer):
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9. If selected for participation in MTIP, I agree to attend all sessions during the week of July 16-July 21, 2024, and will make reasonable efforts, where applicable, to incorporate the lessons learned during MTIP in my classroom or school district during the 2023-2024 academic year. In addition, I will make reasonable efforts to share my experiences and outcomes with other teachers at MTIP and with the Office of Education at the United States Patent and Trademark Office (USPTO):Shape10  Yes Shape11  No

10. I have been employed as a full-time, licensed or certified teacher in an elementary, middle or high school (public or private) in the United States for at least three years:Shape12  Yes Shape13  No

If "No," please specify other and provide details: Shape14

11. I have a strong desire to incorporate “making,” inventing, or innovation into the learning environment as a means for enhancing student interest in STEM learning:Shape15  5 - Strongly agree Shape16  4 - Agree Shape17  3 - Neutral Shape18  2 - Disagree Shape19  1 - Strongly disagree

12. I have an interest in increasing student knowledge and understanding of the concepts of intellectual property, including the creation and protection of intellectual property (patents, trademarks, copyrights, and trade secrets):Shape20  5 - Strongly agree Shape21  4 - Agree Shape22  3 - Neutral Shape23  2 - Disagree Shape24  1 - Strongly disagree

13. Please check all STEM or STEM-related* courses you have taught during the 2023-2024 academic year: (STEM is defined as any course in the area of science, technology, engineering, or mathematics. *STEM-related applies broadly to any content area course that involves the use or application of any field of science, technology, engineering or mathematics or any combination thereof): (Check all that apply)

Shape25  Algebra
Shape26  Biology
Shape27  Botany
Shape28  Calculus
Shape29  Career and Technical Education
Shape30  Chemistry
Shape31  Computer Science
Shape32  Computer-Aided Design
Shape33  Creative Thinking

Shape34  Design Thinking
Shape35  Engineering
Shape36  Geometry
Shape37  Graphic Design
Shape38  Industrial Design
Shape39  Intellectual Property
Shape40  Invention Education
Shape41  Materials Science
Shape42  Mechanics
Shape43  Other Math Course

Shape44  Physics
Shape45  Rapid Prototyping
Shape46  Robotics
Shape47  Technology
Shape48  Trigonometry
Shape49  Visualization
Shape50  Welding/Shop
Shape51  Woodworking
Shape52 Other

if other provide details: Shape53

 

14. Please check all STEM or STEM-related* courses you will teach during the 2024-2025 academic year: (STEM is defined as any course in the area of science, technology, engineering, or mathematics. *STEM-related applies broadly to any content area course that involves the use or application of any field of science, technology, engineering or mathematics or any combination thereof): (Check all that apply)

Shape54  Algebra
Shape55  Biology
Shape56  Botany
Shape57  Calculus
Shape58  Career and Technical Education
Shape59  Chemistry
Shape60  Computer Science
Shape61  Computer-Aided Design
Shape62  Creative Thinking

Shape63  Design Thinking
Shape64  Engineering
Shape65  Geometry
Shape66  Graphic Design
Shape67  Industrial Design
Shape68  Intellectual Property
Shape69  Invention Education
Shape70  Materials Science
Shape71  Mechanics
Shape72  Other Math Course

Shape73  Physics
Shape74  Rapid Prototyping
Shape75  Robotics
Shape76  Technology
Shape77  Trigonometry
Shape78  Visualization
Shape79  Welding/Shop
Shape80  Woodworking
Shape81 Other

if other provide details: Shape82

 

15. Please check examples of either informal or formal educational programs where you have taught or mentored students in areas related to one or more of the following: Invention, Innovation, Making, or Entrepreneurship. (Check all that apply)

Shape83  Computer Science Club
Shape84  Entrepreneurship Club
Shape85  Invention Competitions
Shape86  Inventors Club

Shape87  Making/Design/Do-It-Yourself (DIY) projects
Shape88  Robotics Programs
Shape89  Science Research/Citizen Science Programs

Shape90  Science Fair Projects
Shape91  Scouting
Shape92  4-H
Shape93 Other

if other provide details: Shape94

16. I have a strong desire to improve teaching and learning in either formal or informal environments and especially as it relates to the fields of STEM, innovation, or intellectual property:Shape95  5 - Strongly agree Shape96  4 - Agree Shape97  3 - Neutral Shape98  2 - Disagree Shape99  1 - Strongly disagree

17. Identify what forms of pedagogy you have utilized in your classroom practice that may benefit other educators at MTIP: (Check all that apply)

Shape100  Project-based learning
Shape101  Problem-based learning
Shape102  Engineering design processes
Shape103  Project lead the way
Shape104  Case-based learning
Shape105  Collaborative learning

Shape106  Invention Education
Shape107  Genius Hour
Shape108  5 E (or 7E) approach to learning
Shape109  Culturally responsive instruction
Shape110  Maker education
Shape111 Other

if other provide details: Shape112

 

18. Identify any past awards or training programs that you have participated in: (Check all that apply)

Shape113  National Science Teachers Association (regional or national)
Shape114  State professional association conferences (relevant content)
Shape115  International Society for Technology in Education
Shape116  International Technology and Engineering Educators Association
Shape117  Research Experience for Teachers
Shape118  Lemelson-MIT Invention Programs
Shape119  Invention Convention

Shape120  Science Congress
Shape121  Discovery Education STAR Educator Program
Shape122  Albert Einstein Distinguished Educator Fellowship
Shape123  Department of Education Fellowship Program
Shape124  Presidential Award for Math and Science Teachers Program
Shape125  Henry Ford Teacher Innovator

Shape126  Master Teacher Explain: Shape127

Shape128  Other If other provide details: Shape129

19. Were you able to take any of your knowledge from past programs back to your students or classroom?Shape130  Yes Shape131  No

20. Please share any additional information that may be relevant to your interest in participating in the USPTO Master Teacher in Intellectual Property Program, which will take place during the week of July 16-July 21, 2024. (Please limit your response to 250 words or less). Please include your interest, experience, and motivation for applying to NSTI. For more information, please visit our MTIP page:
Shape132

 

21. Please share your thoughts on any one of the following topics:

Shape133  Your approach to teaching and student engagement
Shape134  Why you are interested in attending MTIP
Shape135  How you engage students in a creative learning environment
Shape136  How you plan to use what you learn about invention and intellectual property education and how this will add value to your classroom

Explain (Please limit your response to 250 words or less)
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Your school's information

22. School name:
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23. School district or county:
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24. School website:
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25. Street:
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26. City:
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27. State or U.S. territory:
                                                                                                                                                                                                                                                                                                                                                                                                                    
Shape143

State Selector

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28. Zip code:
Shape145

29. Name of approving principal or administrator:
Shape146

30. Contact number of approving principal or administrator:
Shape147  (xxx-xxx-xxxx)

31. Email address of approving principal or administrator:
Shape148

32. My school principal or administrator has endorsed my application to the USPTO National Summer Teacher Institute. Endorsement means my principal or administrator is aware of my application to this program and has agreed to support my efforts to take the lessons learned through my participation in MTIP back to the classroom or to my school district. This also includes support by the principal or administrator to make reasonable efforts in sharing learning experiences and outcomes with other teachers at NSTI and with the USPTO:Shape149  Yes Shape150  No

33. I understand that my principal or administrator may be contacted to verify awareness of my application to participate in this program:Shape151  Yes Shape152  No

34. I acknowledge that if I am selected to participate in this program the USPTO may contact my principal or school administrator to verify their endorsement:Shape153  Yes Shape154  No


35. How did you learn about this program? (Check all that apply)

Shape155  USPTO website

Shape156  Social Media (e.g., Facebook, Twitter, LinkedIn)

Identify the social media page: _____________________________________
Shape157  Office of Education Webinar Eventbrite
Shape158  Email announcement

Shape159  Master Teacher of Invention and Intellectual Property Education Program (MTIP)

Shape160  National Summer Teacher Institute (NSTI) Alumni
Shape161  PAEMST Network

Shape162  Albert Einstein Distinguished Educator Network

Shape163  Government Agency

Identify program or agency: ________________________________________________
Shape164  Teacher Conference

Identify conference and session speaker or topic: __________________________
Shape165  Attendance at a previous USPTO event

Shape166  Other (please specify) _________________________________________________________




 

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PRA Statement of Burden

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0077. Public burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected].


Privacy Act Statement

The authority for the collection of this information is 5 U.S.C. § 301, 35 U.S.C. § 2, and E.O. 12862. The information you provide will be used to verify your identity and administer participation in the National Summer Teacher Institute. The information you provide is protected from disclosure to third parties in accordance with the Privacy Act. However, routine uses of this information may include disclosure to the following: Congressional offices; Federal, state, local or foreign agencies; a court, magistrate or administrative tribunal; law enforcement; agents or contractors; the Department of Justice; the National Archives and Records Administration; and agency customers in the course of distributing patent and trademark business information. Disclosure of the information by you is voluntary; however, failure to provide any part of the requested information may result in our inability to enroll you in the program. The applicable Privacy Act System of Records Notice for this information request is Commerce PAT/TM-19, Dissemination Events and Registrations, available at https://www.uspto.gov/uspto-systems-records-notices.


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AuthorDurham, Nona
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File Created2023-12-12

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