Steinbeck Young Authors: Teacher Participation Form

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Name of Middle School *

School Mailing Address *

City *

Zip *

Telephone *

Name of Principal *

Principal has authorized my involvement in the SYA program *

Name of Teacher *

Email address *

Daytime phone number *

Number of classes *

How many classes will you be teaching the Steinbeck Young Authors curriculum with?

Number of students *

Approximately how many students total will you be teaching the Steinbeck Young Authors curriculum with?

Grade level(s) *

What grade level(s) are these students?

Have you previously participated in the Steinbeck Young Authors program? *

If yes, how many years have you participated?

3-5

Clear selection

What dates do you plan to teach the Steinbeck Young Authors curriculum? *

If yes, how many copies?

We have a limited number of copies available on a first come, first served basis

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