Administrator Follow-Up Form

(Please print information)

Following the workshop it is our intent to send a letter of appreciation to one or two administrators at your high school or college.

Please print or type all information clearly and exactly as it should appear.

Your Name [title first (middle) last]

_____________________________________________

Department ________________________________________________

College/High School ________________________________________________

Address ________________________________________________

City, State ZIP ________________________________________________

Chief College/High School Administrator

Name [title first (middle) last]

________________________________________________

Position ________________________________________________

College/High School ________________________________________________

Address ________________________________________________

City, State ZIP ________________________________________________

Other Administrator

Name [title first (middle) last]

________________________________________________

Position ________________________________________________

College/High School ________________________________________________

Address ________________________________________________

City, State ZIP ________________________________________________

Please submit this completed form to Curtis Hieggelke or Tom O’Kuma at the workshop in Beaverton, Oregon or

send it to the Physics Workshops For The 21st Century Project Office, Joliet Junior College, Natural Science Department, 1215 Houbolt Road, Joliet, IL 60431-8938.