Fourth Annual 1997 KITS Summer Institute Application
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Fourth Annual 1997 KITS Summer Institute Application
Kansas Inservice Training System
Kansas University Affiliated Program
2601 Gabriel Parsons, KS 67357
(620) 421-6550 ext 1859 |
University of Kansas Life Span Institute
1052 Dole Lawrence, KS 66045
(913) 864-0725 |
Fourth Annual Summer Institute 1997 Working Together: Regular and Early Childhood Special Education Kansas State University Manhattan, KS June 17 - June 20, 1997
This program is limited to 50 participants. Applications will be reviewed on a regular basis and notification of acceptance to the Summer Institute will be sent by mail. Criteria for selection to the Summer Institute consists of the information provided on this form.
| Personal Information |
| Name |
| Home Address (City, State, Zip) |
| Home phone (include area code) |
| Work address (City, State, Zip) |
| Work phone |
| Fax / EMail |
| Professional Information |
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| Job Title |
| Job Responsibilitie |
| Special Ed Coop |
| Are you employed by the school district? |
(Yes or No) |
| Work phone Do you serve students with special needs? |
(Yes or No) |
| If yes, describe. |
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Educational Information. The Summer Institute must be taken for college credit. |
| Are you currently recognized as a student at a community college or university? |
(Yes or No) |
| If yes, where? (Please indicate the university you will enroll in for credit for the Summer Institute.) |
| ACCK |
Emporia Stae University |
| Fort Hays Stae University |
Kansas State University |
| University of Kansas |
Pittsberg State University |
| Wasburn University |
Wichita State University |
| Other |
| Additional Information |
| How will the Summer Institute impact your professional or personal plan of development? |
| Do you need dormitory housing? |
(Yes or No) |
| Travel reimbursement? |
Yes or No) |
| ($50 maximum) |
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