Form PTO/MTIP/001 MTIP Application

National Summer Teacher Institute (NSTI) and Master Teacher of Invention and Intellectual Property Education Program (MTIP)

0651-0077 PTO MTIP 001 Application Form

MTIP Application

OMB: 0651-0077

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MTIP application form


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PTO/MTIP/001
OMB Control No. 0651-0077
Expiration Date: XX/XX/XXXX

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 of Invention and Intellectual Property Education Program application. For more information, please see the PRA Statement of Burden.


Personal 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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8a. Have you submitted a previous application to the USPTO MTIP Program? Yes, No




Commitment and Experience


9. If selected for participation for MTIP, I commit to attending 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.  Yes  No


9a: After attending MTIP, I will make reasonable efforts to share my experiences and outcomes with other teachers I met at MTIP and with the Office of Education at the United States Patent and Trademark Office (USPTO): (Examples include sharing phots of my students and/or colleagues using the resources or strategies I learned at MTIP)Shape10  Yes Shape11  No



Teaching Experience


10. I have been employed as a full-time/part-time, licensed or certified teacher/instructional specialist or coach 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


Courses


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)


Mathematics: Algebra, Calculus, Geometry, Trigonometry, Other Math Courses


Science: Biology, Chemistry, Physics, Botany, Materials Science


Technology: Computer Science, Computer-Aided Design, Technology, Graphic Design, Industrial Design, Rapid Prototyping


Career and Technical Education


Engineering: Engineering, Mechanics, Robotics, Design Thinking


Business or Entrepreneurship


If Other: Please specify any other STEM or STEM-related courses you have taught during the specified academic year.



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)


Mathematics: Algebra, Calculus, Geometry, Trigonometry, Other Math Courses


Science: Biology, Chemistry, Physics, Botany, Materials Science


Technology: Computer Science, Computer-Aided Design, Technology, Graphic Design, Industrial Design, Rapid Prototyping


Career and Technical Education


Engineering: Engineering, Mechanics, Robotics, Design Thinking


Business or Entrepreneurship


If Other: Please specify any other STEM or STEM-related courses you have taught during the specified academic year.


 

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)

Shape25  Computer Science Club
Shape26  Entrepreneurship Club
Shape27  Invention Competitions
Shape28  Inventors Club

Shape29  Making/Design/Do-It-Yourself (DIY) projects
Shape30  Robotics Programs
Shape31  Science Research/Citizen Science Programs

Shape32  Science Fair Projects
Shape33  Scouting
Shape34  4-H
Shape35 Other

if other provide details: Shape36


Teaching Philosophy


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:Shape37  5 - Strongly agree Shape38  4 - Agree Shape39  3 - Neutral Shape40  2 - Disagree Shape41  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)


Project-based learning: Teaching approach where students actively explore real-world problems and challenges, often working collaboratively to develop solutions and complete a project.


Problem-based learning: Instructional method where students learn through solving complex, authentic problems, fostering critical thinking and problem-solving skills.


Engineering design processes: Utilization of engineering principles and methodologies to engage students in hands-on design projects, encouraging creativity and innovation.


Project Lead the Way: Integration of Project Lead the Way (PLTW) curriculum, which emphasizes hands-on learning experiences in science, technology, engineering, and mathematics (STEM).


Case-based learning: Instructional strategy where students analyze real or hypothetical cases to apply theoretical concepts and develop decision-making skills.


Collaborative learning: Pedagogical approach where students work together in groups to achieve common learning goals, fostering teamwork and communication skills.


Invention Education: Incorporation of invention education principles, promoting creativity, problem-solving, and entrepreneurship through the invention process.


Genius Hour: Implementation of Genius Hour or 20% Time, allowing students to pursue self-directed learning projects based on their interests and passions.


5 E (or 7 E) approach to learning: Adoption of the 5E or 7E instructional model (Engage, Explore, Explain, Elaborate, Evaluate) to guide student-centered inquiry-based learning experiences.


Culturally responsive instruction: Tailoring teaching practices to meet the diverse cultural and linguistic needs of students, fostering inclusivity and equity in the classroom.


Maker education: Integration of maker-centered learning experiences, where students engage in hands-on, creative problem-solving activities using various tools and materials.


Other: Please specify any other teaching philosophies or methodologies you have utilized in your classroom practice that may benefit other educators at MTIP



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

Shape42  National Science Teachers Association (regional or national)
Shape43  State professional association conferences (relevant content)
Shape44  International Society for Technology in Education
Shape45  International Technology and Engineering Educators Association
Shape46  Research Experience for Teachers
Shape47  Lemelson-MIT Invention Programs
Shape48  Invention Convention

Shape49  Science Congress
Shape50  Discovery Education STAR Educator Program
Shape51  Albert Einstein Distinguished Educator Fellowship
Shape52  Department of Education Fellowship Program
Shape53  Presidential Award for Math and Science Teachers Program
Shape54  Henry Ford Teacher Innovator

Shape55  Master Teacher Explain: Shape56

Shape57  Other If other provide details: Shape58


Integration and Application


19. Were you able to take any of your knowledge from past programs back to your students or classroom?Shape59  Yes Shape60  No


If yes, please explain with specific examples:


20. Please share any additional information that may be relevant to your interest in participating in the USPTO National Summer Teacher IMTIPtute, which will take place during the week of [Date]. (Please limit your response to 250 words or less). Please include your interests, experiences, and motivation for applying to MTIP and consider sharing how you have taken knowledge from past training experiences and incorporated into classroom instruction. For more information, please visit our MTIP FAQ page:
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Essay Response

 

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

Shape62  Your approach to teaching and student engagement
Shape63  Why you are interested in attending MTIP
Shape64  How you engage students in a creative learning environment
Shape65  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:
                                                                                                                                                                                                                                                                                                                                                                                                                    
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State Selector

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28. Zip code:
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29. Name of approving principal or administrator:
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30. Contact number of approving principal or administrator:
Shape76  (xxx-xxx-xxxx)

31. Email address of approving principal or administrator:
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32. My school principal or administrator has endorsed my application to the USPTO MTIP. 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 MTIP and with the USPTO:Shape78  Yes Shape79  No



33. 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:Shape80  Yes Shape81  No




How You Heard About Us


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

Shape82  USPTO website

Shape83  Social Media (e.g., Facebook, Twitter, LinkedIn)

Identify the social media page: _____________________________________
Shape84  Office of Education Webinar Eventbrite
Shape85  Email announcement

Shape86  Master Teacher of Invention and Intellectual Property Education Program (MTIP)

Shape87  National Summer Teacher IMTIPtute (MTIP) Alumni
Shape88  PAEMST Network

Shape89  Albert Einstein Distinguished Educator Network

Shape90  Government Agency

Identify program or agency: ________________________________________________
Shape91  Teacher Conference

Identify conference and session speaker or topic: __________________________
Shape92  Attendance at a previous USPTO event

Shape93  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 IMTIPtute. 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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