The Examined Life - Greek Studies in the Schools

Application



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Gnothi Sauton

Know Thyself

Application Form for Fellowship in
The Examined Life Program

Peconic Teacher Center Southampton NY
The Examined Life: Greek Studies in the Schools
Brigid Collins, Director of Peconic Teacher Center
www.peconicteachercenter.org
Fax: 631-283-1905

Instructions

Please complete the following information and submit online by clicking the "Submit" button at the end of the form. OR, If you prefer, print the form, complete the information, and mail it to the address shown above. Note, you must fill out the ENTIRE form in order to successfully submit the Application online.

First Name:
Last Name:
Today's Date:
Work:
School Name:
Street Address:
City/Town:
State:
Zip:
Phone:
Email
Job Title:
Subject Taught:
Grade Taught:
Years Experience:
Home:
Street Address:
City/Town:
State:
Zip:
Phone:
Email:
Have you been to Greece before?	Yes No
Is Greece currently a part of your curriculum?	Yes No
What do you hope to get out of the Greek Studies Program (use as much space as necessary)?
What do you hope to bring to the program (use as much space as necessary)?

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