Application Form Secondary teachers application forms 2024 Please fill all the following fields only in Latin alphabet without any intonations and only in English language 1. Personal details Name * Name First First Last Last Gender * Female Male Prefer not to say Other Email * Confirm Email * Confirm Email Country of residence * AustriaBelgiumCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLuxembourgThe NetherlandsNorwayPolandPortugalRomaniaSpainSwedenSwitzerlandUnited KingdomCanadaLatviaLithuaniaSloveniaSlovakiaMalta Nationality * 2. The school and your role What type of school are you currently working in? * Primary Secondary Name of School * School Address Line 1 * School Address Line 2 School Address Postcode * School Address Town/City * School Address Region/Country * Your role in the school * Teacher Director Educator OtherOther Please select the age of your students (multiple selections possible) * 6-8 years old 8-10 years old 10-12 years old 12-14 years old 14-16 years old 16-19 years old OtherOther Please specify which subject you teach (multiple selections possible) * Biology Chemistry ICT Mathematics Physics Sciences Technology OtherOther Where did you hear about ESA's Teach with Space Teacher Trainings? * ESA Education Website ESA Education Newsletter Social Media Colleague(s) ESERO in my country OtherOther 3. Application Please indicate the teacher training opportunity you would like to apply for. * logo acf-forms activecampaign authorize aweber bootstrap campaignmonitor constant_contact getresponse googlesheets highrise hubspot mailchimp mailpoet paypal icon polylang salesforce salesforcealt stripe stripealt twilio woocommerce Zapier required delete move drag clear noclear duplicate copy clone tooltip tooltip_solid forbid checkmark image checkmark circle checkmark square check check1 plus plus1 plus2 plus3 plus4 minus minus1 minus2 minus3 minus4 cancel cancel1 close report_problem_solid report_problem arrowup arrowup1 arrowup2 arrowup3 arrowup4 arrowup5 arrowup5_solid arrowup7 arrowup6 arrowup8 arrowdown arrowdown1 arrowdown2 arrowdown3 arrowdown4 arrowdown5 arrowdown5_solid arrowdown7 arrowdown6 arrow_left arrow_right filter download upload2 download2 hard_drive pencil_solid pencil signature register account_circle_solid account_circle address_card paragraph checkbox_unchecked checkbox checkbox_solid dropdown caret_square_down radio_unchecked scrubber location_solid location toggle_on toggle_off shield_check shield_check_solid clock clock_solid email_solid mail_bulk code tag tag_solid price_tags search sitemap file file_text_solid file_text option option_solid more_horiz more_vert more_horiz_solid more_vert_solid calculator key key Filled Key Icon keyboard eye eye_solid eye_slash_solid page_break view_day attach_file printer header h1 repeat repeater save sliders code_commit star star_full star_half linear_scale pie_chart stats_bars sms feed align_right align_left button browser cloud_upload_solid shuffle swap pallet fingerprint ghost heart_solid heart history import export label_solid label lock_open lock alt_lock dollar_sign percent notification external_link pageview_solid pageview settings stamp support text white_label building icontact sendinblue sendy wordpress credit_card credit_card_alt cc_amex cc_discover cc_mastercard cc_visa cc_paypal icon cc_stripe price product total quantity directory Preview Teach with Earth from Space 12-13 December Have you ever attended in-person any previous on-site ESA workshops in Galaxia, Belgium? * Yes No If yes, please specify the type and date of all the workshops that you attended so far. * Why would you like to attend this type of ESA Teach with Space Teacher Training? (200 words limit - Please complete this field in English) * Visual Text Have you previously participated in any non-ESA workshop/training about using 'space' as a context for teaching STEM (Science, Technology, Engineering and Mathematics) subjects? * Yes No If yes, please give some details. 4. Consent By submitting your personal information you agree to ESA framework on Personal Data Protection and to the processing of your personal data by or on behalf of the Agency as mentioned in the ESA Privacy Notice: * I Agree I Disagree Please note that if consent is not provided for this, you will not be able to be selected for the workshop I agree for my contact details (name/email address) to be processed by ESA, after the conclusion of the teacher training, in order to be informed (individually, through emailing list, or newsletters) about future free-of-charge education opportunities and activities, and about additional possibilities to be involved. No Yes I agree for my contact details (name, email address, school or organisation type, subjects of teaching/mentoring) to be shared by ESA with the ESA ESERO Office in my country, where the processing takes place in accordance with their Privacy Policy / national regulations (links available in Table 2 of the ESA Education Teacher Training Privacy Notice), solely for the following purposes: in order for me to be informed (individually, through emailing list, or newsletters) by ESERO about future free-of-charge education opportunities and activities, and about additional possibilities to be involved. No Yes I agree for my contact details (name, email address, school or organisation type, subjects of teaching/mentoring) to be processed by the national Space Agency/Office/ESA Delegation of my country in accordance with their Privacy Policy/ national regulations (links available in Table 3 of the ESA Education Teacher Training Privacy Notice), solely for the following purposes: in order for me to be informed (individually, through emailing list, or newsletters) by Space Agency/Office/ESA Delegation of my country about future free-of-charge education opportunities and activities, and about additional possibilities to be involved. No Yes Submit If you are human, leave this field blank.
