KIDS FROM KA-NA-TA 2005-2006

APPLICATION FORM AND CONTACT INFORMATION

Please print, then send or fax this form to:
KIDS FROM KA-NA-TA 
RR #1 Thornbury, ON N0H 2P0             Fax: 519 599-5020  Phone: 519 599-7020.

CONTACT INFORMATION

Name of main teacher _________________________

Contact person (if different) ______________  Position ________________ 
        
Name of principal __________________  School board ___________________  

School name ___________________  Purchase Order number  ______________

Address ______________________________________  

City __________________  Province ____  Postal code ___________

School phone (___)___________    Fax ____________  Home phone ______________

Where should we send your registration invoice ($279)? School __   Schoolboard __

Class Info:

Grade level ____ Subject area ____ Number of students ____  Aboriginal Students ___

Have you done this project before or one like it? ___________________

Where did you hear about this program? ___________________

CONNECTIVITY TO THE INTERNET

Many teachers like to log in to the project from home as well as from the classroom. This can be very helpful for keeping up with the online activity and being prepared when your students are ready to go.

Internet access:   __ Class Modem  __ School Network   __ Home

Computer System: __ Macintosh  __  Windows    E-mail address?  _____________________

SPECIAL OPPORTUNITIES

Are you interested applying for funding ($300) to cover program registration (we are still looking for sponsors to cover these costs as the GrassRoots program has been discontinued)?                                                                      Yes ___      No ___

Are you interested in applying for a class exchange visit with a partner school?  (Note:preference given to applications received by October 7, 2005)                                                                                                                               Yes ___      No ___

 

Teacher's Signature______________ Date ___________________


Principal's Agreement_____________________