Mars Workshop
Jet Propulsion Laboratory
July 2-6, 1997

Applicant's Name:
Home Address:
City:
Phone/Home:
Email/Home:
U.S. Citizen:   Yes                     No              

School Type:        Rural                   Suburban                        Urban   

How long have you been teaching?

School Name:
School Address:
City:                                   State:          Zip:
Phone/School:                   Fax:
Email/School:
Does you school provide Internet Access for its Teachers?
        Yes                     No              

Teaching Assignments (Grade levels K-12)?

Subject Areas:
        Science                 Mathematics             Technology

        Self Attained           Other Subjects (List)

Have you attended a JPL Mars Workshop? 
                        Yes             No

If Yes, Location:           Date:





Completion of this section is Voluntary

Gender:             Male            Female

Race:                   African American
                        Asian American
                        Caucasian
                        Hispanic
                        Native American
                Other:                  

This application must be completed and received by June 6, 1997. 
Selected applicants will be notified by June 14, 1997.

There will be a registration fee of $25.00 which will be required after the Selection.

If selected I am Interested in attending the Planetfest '97 activities, July 4-6, 
at an additional discounted cost of $20.00.

Send Applications to:

Dr. Cheick Diarra
Jet Propulsion Laboratory
Mail-Stop T-1129
4800 Oak Grove Drive
Pasadena, CA 91109
email: cheick.m.diarra@jpl.nasa.gov

Questions may be directed to Ms. Cathy Davis at:
Phone:  (818) 354-6111
email:  catherine.l.davis@jpl.nasa.gov