A River Runs Through It (ARRT)
Teacher Institute

APPLICATION

Personal Information:
Name:  _______________________________________________________

Address: _______________________________________________________

City: __________________ State: __________________ Zip: _____________ 

Email Address: ___________________________________________________    

Home Ph # : ______________________ Work Ph # : ____________________    

School Information: 
School Name: ____________________________________________________   

School Address: ___________________________________________________

City: __________________ State: __________________ Zip: _____________ 
  
School Ph #: ______________________________________________________ 
   
Are there other teachers from your school that plan to participate? 
If Yes, what are their names?  

1. _________________________________________________

2. _________________________________________________

3. _________________________________________________

4. _________________________________________________
  
 I am a student at The University of Toledo:  (circle one)			Yes 	No	
 I plan to enroll with Special Student Status:  (circle one)			Yes 	No
 I am interested in earning semester credit for participation: (circle one)	Yes 	No 
    
How did you find out about the ARRT program? _______________________________________  

Mail completed form to: 

Dr. Charles Rop
The University of Toledo
College of Education
Snyder Memorial – Room 3140
MS # 106
Toledo, Ohio 43606