NSTI application form

PTO/NSTI/001
OMB Control No. 0651-0077
Expiration Date: 08/31/2024

Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

All fields are required to complete the National Summer Teacher Institute (NSTI) application. For more information, please see the PRA Statement of Burden.

Your Information

1. First name:

2. Last name:

3. Street:

4. City:

5. State or U.S. territory:

6. Zip code:

7. Telephone (where you can be reached this summer):
(xxx-xxx-xxxx)

8. E-mail address (that you have access to this summer):

9. If selected for participation in NSTI, I agree to attend all sessions during the week of July 21-July 26, 2024, and will make reasonable efforts, where applicable, to incorporate the lessons learned during NSTI in my classroom or school district during the 2023-2024 academic year. In addition, I will make reasonable efforts to share my experiences and outcomes with other teachers at NSTI and with the Office of Education at the United States Patent and Trademark Office (USPTO): Yes No

10. I have been employed as a full-time, licensed or certified teacher in an elementary, middle or high school (public or private) in the United States for at least three years: Yes No

If "No," please specify other and provide details:

11. I have a strong desire to incorporate “making,” inventing, or innovation into the learning environment as a means for enhancing student interest in STEM learning: 5 - Strongly agree 4 - Agree 3 - Neutral 2 - Disagree 1 - Strongly disagree

12. I have an interest in increasing student knowledge and understanding of the concepts of intellectual property, including the creation and protection of intellectual property (patents, trademarks, copyrights, and trade secrets): 5 - Strongly agree 4 - Agree 3 - Neutral 2 - Disagree 1 - Strongly disagree

13. Please check all STEM or STEM-related* courses you have taught during the 2023-2024 academic year: (STEM is defined as any course in the area of science, technology, engineering, or mathematics. *STEM-related applies broadly to any content area course that involves the use or application of any field of science, technology, engineering or mathematics or any combination thereof): (Check all that apply)

Algebra
Biology
Botany
Calculus
Career and Technical Education
Chemistry
Computer Science
Computer-Aided Design
Creative Thinking

Design Thinking
Engineering
Geometry
Graphic Design
Industrial Design
Intellectual Property
Invention Education
Materials Science
Mechanics
Other Math Course

Physics
Rapid Prototyping
Robotics
Technology
Trigonometry
Visualization
Welding/Shop
Woodworking
Other

if other provide details:

14. Please check all STEM or STEM-related* courses you will teach during the 2024-2025 academic year: (STEM is defined as any course in the area of science, technology, engineering, or mathematics. *STEM-related applies broadly to any content area course that involves the use or application of any field of science, technology, engineering or mathematics or any combination thereof): (Check all that apply)

Algebra
Biology
Botany
Calculus
Career and Technical Education
Chemistry
Computer Science
Computer-Aided Design
Creative Thinking

Design Thinking
Engineering
Geometry
Graphic Design
Industrial Design
Intellectual Property
Invention Education
Materials Science
Mechanics
Other Math Course

Physics
Rapid Prototyping
Robotics
Technology
Trigonometry
Visualization
Welding/Shop
Woodworking
Other

if other provide details:

15. Please check examples of either informal or formal educational programs where you have taught or mentored students in areas related to one or more of the following: Invention, Innovation, Making, or Entrepreneurship. (Check all that apply)

Computer Science Club
Entrepreneurship Club
Invention Competitions
Inventors Club

Making/Design/Do-It-Yourself (DIY) projects
Robotics Programs
Science Research/Citizen Science Programs

Science Fair Projects
Scouting
4-H
Other

if other provide details:

16. I have a strong desire to improve teaching and learning in either formal or informal environments and especially as it relates to the fields of STEM, innovation, or intellectual property: 5 - Strongly agree 4 - Agree 3 - Neutral 2 - Disagree 1 - Strongly disagree

17. Identify what forms of pedagogy you have utilized in your classroom practice that may benefit other educators at NSTI: (Check all that apply)

Project-based learning
Problem-based learning
Engineering design processes
Project lead the way
Case-based learning
Collaborative learning

Invention Education
Genius Hour
5 E (or 7E) approach to learning
Culturally responsive instruction
Maker education
Other

if other provide details:

18. Identify any past awards or training programs that you have participated in: (Check all that apply)

National Science Teachers Association (regional or national)
State professional association conferences (relevant content)
International Society for Technology in Education
International Technology and Engineering Educators Association
Research Experience for Teachers
Lemelson-MIT Invention Programs
Invention Convention

Science Congress
Discovery Education STAR Educator Program
Albert Einstein Distinguished Educator Fellowship
Department of Education Fellowship Program
Presidential Award for Math and Science Teachers Program
Henry Ford Teacher Innovator

Master Teacher Explain:

Other If other provide details:

19. Were you able to take any of your knowledge from past programs back to your students or classroom? Yes No

20. Please share any additional information that may be relevant to your interest in participating in the USPTO National Summer Teacher Institute, which will take place during the week of July 21-July 26, 2024. (Please limit your response to 1000 characters(with spaces) or less). Please include your interest, experience, and motivation for applying to NSTI. For more information, please visit our NSTI FAQ page:

21. Please share your thoughts on any one of the following topics:

Your approach to teaching and student engagement
Why you are interested in attending NSTI
How you engage students in a creative learning environment
How you plan to use what you learn about invention and intellectual property education and how this will add value to your classroom

Explain (Please limit your response to 1000 characters(with spaces) or less)

Your school's information

22. School name:

23. School district or county:

24. School website:

25. Street:

26. City:

27. State or U.S. territory:

28. Zip code:

29. Name of approving principal or administrator:

30. Contact number of approving principal or administrator:
(xxx-xxx-xxxx)

31. Email address of approving principal or administrator:

32. My school principal or administrator has endorsed my application to the USPTO National Summer Teacher Institute. Endorsement means my principal or administrator is aware of my application to this program and has agreed to support my efforts to take the lessons learned through my participation in NSTI back to the classroom or to my school district. This also includes support by the principal or administrator to make reasonable efforts in sharing learning experiences and outcomes with other teachers at NSTI and with the USPTO: Yes No

33. I understand that my principal or administrator may be contacted to verify awareness of my application to participate in this program: Yes No

34. I acknowledge that if I am selected to participate in this program the USPTO may contact my principal or school administrator to verify their endorsement: Yes No

35. How did you learn about this program? (Check all that apply)

USPTO website
Office of Education Webinar Eventbrite
Email announcement
Master Teacher of Invention and Intellectual Property Education Program (MTIP)
National Summer Teacher Institute (NSTI) Alumni
PAEMST Network
Albert Einstein Distinguished Educator Network

Social Media (e.g., Facebook, Twitter, LinkedIn), please specify:

Government Agency, Identify program or agency, please specify:

Teacher Conference, Identify conference and session speaker or topic, please specify:

Attendance at a previous USPTO event

Other please specify:

PRA Statement of Burden

The United States Patent and Trademark Office (USPTO) is using this form as an application for the National Summer Teacher Institute. This application is voluntary, includes questions and should take approximately 30 minutes to complete. This information collection contains requirements subject to the Paperwork Reduction Act (PRA). Notwithstanding any other provisions of the law, no person is required to respond to, nor shall any person be subject to penalty for failure to comply with, a collection of information subject to the requirements of the PRA, unless that collection of information displays a currently valid OMB control number. Please direct comments on the time needed to complete this worksheet, and/or suggestions for reducing this burden to the Chief Administrative Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450.

Privacy Act Statement

The authority for the collection of this information is 5 U.S.C. § 301, 35 U.S.C. § 2, and E.O. 12862. The information you provide will be used to verify your identity and administer participation in the National Summer Teacher Institute. The information you provide is protected from disclosure to third parties in accordance with the Privacy Act. However, routine uses of this information may include disclosure to the following: Congressional offices; Federal, state, local or foreign agencies; a court, magistrate or administrative tribunal; law enforcement; agents or contractors; the Department of Justice; the National Archives and Records Administration; and agency customers in the course of distributing patent and trademark business information. Disclosure of the information by you is voluntary; however, failure to provide any part of the requested information may result in our inability to enroll you in the program. The applicable Privacy Act System of Records Notice for this information request is Commerce PAT/TM-19, Dissemination Events and Registrations, available at https://www.uspto.gov/uspto-systems-records-notices.