Shoman Foundation: Application Form

Application for the Award

Application for the Science Award

Personal Information :

First Name *:

Middle Name *:

Grandfather *:

Last Name *:

School at which teacher is employed :

School Name *:

School at which teacher is employed :

Affiliation *:

Public UNRWA Private Armed Forces

Mailing Address :

P.O.Box :

Postal Code :

Sector/Town :

Phone No.(work) :

Phone No.(Home) :

Mobile(if available) :

Fax No(if available) :

E-mail(if available) :

Academic Degree(s) Earned :

	Nominee’s specific specialization	Graduation Date	University	Country
Bachelor’s Degree
Master’s
Other (specify)

Teaching Experience (teaching, working in labs) :

Experience using computers in teaching science :

Science Project :

Title *:

Objectives of Project *:

Description of Project :

Importance of Project in Teaching Science *:

Stages of implementing the project, and time frame required for each stage: :

Detailed table of projected costs of implementing the project *:

Knowledge Sources needed for implementing the project :

Books and References :

Scientific Magazines :

Computer Programs :

Internet :

Other Sources :

Additional comments by individual submitting the application :

School Principal notes, signature and school official seal :