Name:

Phone:

Email:

Home Address:

Work Address:

School:

Subjects Taught:

Grade Taught:

Length of Time Teaching:

Are you currently including topics about Africa in lesson plans? Yes No
If yes, under what topics?

Have you taken any course or participated in any workshops relating to Africa?

What would you like to gain from the workshop?

Are there any specific topics you would like to see covered?

Would you like graduate credit from the workshop? Yes No

Are you interested in child care during the workshop? Yes No
If so, what are the ages of your children?