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Event Leader Training Application Form
Fax to Kristin Nelson (415) 337-5205, email to knelson@astrosociety.org or send to Family ASTRO, Astronomical Society of the Pacific, 390 Ashton Avenue, San Francisco, CA 94112 Applications are due by Friday, September 24, 2004. (Late applications may be accepted, if space allows.)

Contact Information
Name ______________________________ School/Organization____________________________ Address (street/city/zip): _____________________________________________________________ Phone: __________________________________ E-mail: ________________________________ __ I am new to your project I have been involved with Project ASTRO. I have attended a Family ASTRO training event before and learned to facilitate the following kit(s) (circle all that apply): Race To The Planets Moon Mission Night Sky Adventure Cosmic Decoder I rate my knowledge of the night sky on a scale of 1-10 (1 little knowledge, 10 very knowledgeable) as: I am a (please check all that apply): elementary school teacher middle school teacher amateur astronomer professional research astronomer graduate student / Post Doc museum/planetarium educator Are you bilingual? What languages do you speak?



high school teacher retired research astronomer community/youth group leader other _________ ____

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Why are you interested in participating in this program? What goals related to Family ASTRO do you have?

________________________________________________________ ________________________________________________________ ________________________________________________________
What is the name of the organization that will host your Family ASTRO Event(s) and where is it located?

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By signing this form and attending the leader training, I agree to lead at least two family events within the next 12 months, and to work with Family ASTRO staff to help evaluate the program. If I am a teacher, I certify that I have the approval of my principal or other administrator to participate in this activity. Signature ______________________________________ Date _________________________