Supporting Immersion Learners -
Summer Institute 2010 Application

The information provided on this form will be used by the Second Language Research Institute of Canada for the administration and management of the "Supporting Immersion Learners" Summer Institute. Should you have any questions regarding the collection or use of the personal information you have provided, please contact Dr. Joseph Dicks, Executive Director, Second Language Research Institute of Canada.

I consent to provide the following information.

Name:
Email Address:
Home Street Address:
Home Address City:
Province:
Home Postal Code:
Home Phone Number:
Cell Phone Number:
School District:
School:
School Street Address:
School Town/City:
School Postal Code:
School Phone Number:

Please provide the following information for selection purposes:

What is the main position you currently hold in your school/district?

If other, please define:

At what grade level(s) are you currently working?

In what program are you currently working?

If other, please define:

Why is this institute of interest to you? (Max. 600 characters)

What are your professional goals for this institute? (Max. 600 characters)

How might this institute complement your school improvement plan?
(Max. 600 characters)

Briefly describe your experience with struggling learners. (Max. 600 characters)

Have you had previous professional development in the area of assisting struggling learners? If so, please describe. (Max. 600 characters)

The summer institute uses a case study approach as part of the teaching/learning process. Please indicate your first, second and third choice using the selections below. For a complete description of each case study, please visit http://www.unbf.ca/L2/institute2010/documents/Case_Studies_Mar18.pdf.

Choice 1:
Choice 2:
Choice 3:

University Course Credit

It is possible to obtain university credit, either MEd or undergraduate,
for work completed during and as a follow-up to this Institute. This would
require registering through UNB and paying the course fees. For more
information, please visit our web site at http://www.unbf.ca/L2/institute2010/credit.html

Will you be seeking university credit?

Selection Process

Confirmation emails will be sent ONLY to those applicants selected. Those selected will be required to send a $50 confirmation fee that will be returned upon completion of the institute.

If the words below are not clear, click on the first button to the right of the yellow box for new words. If you type the words that appear and you get an error message, click the same button and re-type the new set of words.