| A. About You |
| First and Last Name: |
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| Name you wish to go by (If different): |
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| How did you learn about the Summer Institute: |
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| Home Mailing Address: |
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| Phone: |
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| Work Email: |
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| Other Email: |
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| Special Dietary Needs: |
Vegetarian Vegan Other |
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| Where will you be staying during the Summer Institute: |
Please select
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| B. About Your Educational Context |
| Check if you are a college student, and skip to number 7. |
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| 1. Your role/position(classroom or community teacher, a media specialist/librarian, an administrator,etc.)
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| 2. The name and street address of the school or organization where you work
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| 3. The audience/student body with whom you typically work(ages or grade levels, special characterisitics, etc.
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| 4. The contact time that you have with them
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| 5. The type and level of material taught or used (academic subjects covered,etc.)
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| 6. A description of and degree to which you work in collaboration with other groups (e.g. museums, cooperative extension)
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| 7. College Students Only: What program are you currently in, and what subjects and grade levels do you plan on teaching on the future?
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| C. About your interests |
| The following information will help us plan the presentations and mini-lessons on Wednesday and Thursday of the Summer Institute.
Please select up to 4 topics related to media literacy that you would be most interested in learning more about during this institute:
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| D. Familiarity with Media Literacy |
| 1. Have you ever been at a presentation by Chris Sperry or Cyndy Scheibe (from Project Look Sharp) about media literacy
before? If yes, how long(e.g., full-day training,workshop,etc.) and where?
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| 2. Have you ever used any of the Project Look Sharp curriculum kits or other materials? If yes, please describe.
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| 3. Have you attended other training or workshops about media literacy? If yes, describe.
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| E. Do you already have a project tentatively planned for integrating media literacy into your education context
Yes No
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| If yes, please describe briefly, including whether it has a possible media production component.
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| Note: Please bring materials that you might want to include in a media project(e.g., print material to scan, VHS tapes that
you might want excerpts from, DVDs, etc.)
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F. About your experience with technology & digital media production
We will be using/providing MacBook laptops during the institute. These laptops will be available during institute hours only.
You may bring your own laptop if you desire.
Indicate your level of experience and interest below by selecting on the dropdown boxes |
| Video Camera Operation |
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| Presentation Software |
| Voice Thread, Prezi |
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| Digital Video Editing |
| iMovie |
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| Digital Still Photography |
| Image Editing, Photoshop, Gimp, PicMonkey |
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| Scanning |
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| Digital Audio Editing |
| Audio/Radio Production |
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| Garage Band |
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| SoundCloud, Audiobooks |
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| Web 2.0 Tools for Communication/Collaboration |
| Social Bookmarking (Diggo) |
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| Photo Sharing (Flickr,Picasa) |
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| Wikis (collaborative website building) |
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| Voicethread |
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| Google Tools |
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| Are your students able to access mobile learning devices fairly easily (i.e., Ipods, PDAs, Smart Phones, Laptops, Tablets)? If yes, please describe.
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| Please tell us anything regarding technology that you feel will help us better understand and meet your needs regarding the afternoon production component.
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| What computer platform(s) you are proficient using? Mac PC |
| 8. Which platform(s) are you most likely to be working on next year?
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| At Work: |
Mac PC |
| At Home: |
Mac PC |
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