Registration Form

Second Annual Reflective Practices Institute:
Teaching Smart Through Reflective Practice: Creating Spaces for Urban School Success

Date: November 11, 2004 (Veteran’s Day)
Time: 8:30 a.m. – 12:30 p.m.
Location: St. John’s University, Kelleher Center, Staten Island Campus

Name:

________________________________________________________________________________

Professional Title:

________________________________________________________________________________

Organizational Affiliation:

________________________________________________________________________________

Home or Work Address:

________________________________________________________________________________

City: _________________________________________________________
 
State:____________________ Zip: ________________________________

Phone No:_____________________________________________________

E-mail Address: ________________________________________________

You must indicate your first and second preferences among the six concurrent sessions by circling the session and then numbering one and two. An effort will be made to accommodate you, but space is limited at each session. Session assignments will be posted on the day of the conference.

Session One  I  Session Two  I  Session Three  I  Session Four  I  Session Five  I  Session Six

Signature:

________________________________________________________________________________


Mail or Fax this coupon to:
Fay Dimino
St. John’s University
300 Howard Avenue
Staten Island, NY 10301
Fax: (718) 390-4273

This coupon may be duplicated, but a limit may be placed on per school attenders. Free Admission Seating is limited R.S.V.P. before November 4, 2004.

For More Information:
Dr. Jeffrey Glanz
Wagner College
(718) 420-4070
jglanz@wagner.edu

Dr. Steven Kuntz
St. John’s University
(718) 390-4506
kuntzs@stjohns.edu