Application Form Application Primary teachers Robotics workshop: 08-09 February 2024 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 KingdomCanadaLatviaLithuaniaSlovakiaSloveniaMalta 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/County * 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 Teachers Workshop? ESA Education Website ESA Education Newsletter Social Media Colleague(s) ESERO in my country OtherOther 3. Motivation Have you attended any previous ESA workshops? * Yes No If yes, please give some details. Why would you like to attend this workshop? (200 words limit) * Based on a school subject that you teach and using space as a context, can you give an example of a project/activity/practice that could be implemented in your lessons? (200 words limit) * 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 Accept 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 If you are human, leave this field blank. Submit
