Sign Up To register for the MATLC Core Program, please complete and submit the following form. Note: The form fields will scroll to accommodate more text. Contact Information First Name Last Name Position School District School Name School Address School URL City/Town State   Zip  County School Phone     Home Phone Email Address May we contact you at this email address regarding this institute? Yes No If no, please indicate how we might contact you: Important: We need you to create a unique ID to protect the confidentiality of your responses. Please make a six digit number using the month you were born and the last four digits of your Social Security Number. The month you were born. 01 02 03 04 05 06 07 08 09 10 10 11 12 Last four digits of your Social Security Number Superintendents:     Grade span in your district Lowest Grade NA K 1 2 3 4 5 6 7 8 9 10 11 12 >12 Highest Grade  NA K 1 2 3 4 5 6 7 8 9 10 11 12 >12 Principals:     Grade span in your district Lowest Grade NA K 1 2 3 4 5 6 7 8 9 10 11 12 >12 Highest Grade  NA K 1 2 3 4 5 6 7 8 9 10 11 12 >12   Other -- describe: School Type ( Check all that apply) Public Charter Independent Parochial 2004 PROGRAM INFORMATION All cohorts will be held at MESPA Technology Center, Marlborough [ Directions ] unless otherwise indicated Cohort 29 February 11,12, March 19, 2004 Cohort 30 March 1, 2, 31, 2004 Cohort 31 April 1, 2, May 7, 2004 Please indicate your 1st, 2nd, and 3rd choice below First Choice Cohort 29 - February 11, 12, March 19, 2004 Cohort 30 - March 1, 2, 31, 2004 Cohort 31 - April 1, 2 May 7, 2004 Second Choice Cohort 29 - February 11, 12, March 19, 2004 Cohort 30 - March 1, 2, 31, 2004 Cohort 31 - April 1, 2 May 7, 2004 Third Choice Cohort 29 - February 11, 12, March 19, 2004 Cohort 30 - March 1, 2, 31, 2004 Cohort 31 - April 1, 2 May 7, 2004 Please contact Kathi Lengel at kmlengel@mespa.org for additional workshops to be scheduled after April 10. Sessions each day run from 8:30 AM - 4:30 PM and include breakfast/lunch. All cohorts are held at MESPA Technology Center, Marlborough, unless otherwise indicated COST FOR THE CORE INSTITUTE: $200 principals, superintendents, and Other Administrators (4 days face-to-face and online) Form of Payment P.O. #       Please be sure your name and cohort number are included on your purchase order. Check: Mail a check to the following address. MESPEF / MESPA Technology Center 28 Lord Road - Suite 125 Marlborough, MA 01752 I am a principal or superintendent in Boston or Quincy. The State Street Corporation       is paying my tuition. Hotel Accommodations in Marborough Best Western 508 460-0700 $99 / night Embassy Suites 508 485-5900 $129 / night Hampton Inn 508 787-9888 $99 / night   Site updated January 20, 2004 © M.A.S.S., MESPA, EDC, HARVARD, MNEP, TERC, 2000-2004 Web site developed by EDC, Center for Online Professional Development (COPE)