Teacher Information Sheet

Name____________________________________________________________

Address__________________________________________________________

City____________________________________State_______Zip____________

Phone:___________________________________________________________

Email_____________________________________________________________

SDP Membership Number____________________________________________

What chapter do you belong to?______________________________________

*******************************************************************

Office Use Only

Date Arrived___________________________

Project #1: Category:__________Selection #:__________Disposition:________________

Project #2: Category:__________Selection #:__________Disposition:________________

Project #3: Category:__________Selection #:__________Disposition:________________