February 22, 2012
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Starlab Checkout Form
Any questions about the use of Starlab, or any problems with the Starlab must be directed to: Julie Cox julie.cox@riroe.com or Amy Sandgren amy.sandgren@riroe.com
2011 - 2012 Scheduling for Starlab (Portable Planetarium)
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This year's scheduling for Starlab is now open! Teachers planning to use this portable planetarium are reminded that htey must have formal Starlab Training and trasport the equipment. The new user picks up the unit where it was last used the Starlab contact person from each school fills out a checklist. To schedule, please complete the loan request and send it to the Regional Office of Education. NOTE: Cost of repair and/or replacement of damaged equipment shall be the responsibility of the School District. The Regional Office of Education is exempt from any and all liabilities for physical injuries resulting from the transportation or use of Starlab.
Today's Date
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School District making the request
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Building where Star Lab is to be used
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Requested Dates for use
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Alternative dates for use
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Person making the request
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Phone number
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Email Address
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Name of person with the Starlab Training that will be operating the unit
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Location of unit for pick up by the next user
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Attention: New Requirements for the Use of Starlab! We want Starlab to be in top condition for all of our schools!
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To ensure the working operation of Starlab and maintain the materials included with the use of Starlab, the ROE requires each school to complete a Starlab checklist. Each school must complete and sign this checklist before "handing off" the Starlab to the next school. It is the responsibility of the trained teacher to contact the ROE if any material are missing or not working properly. If you do not complete this checklist or are responsible for missing items, your school may lose its right to use the Starlab. In order to maintain the Starlab and make any needed repairs, we need to conduct an inventory and when needed, repair the Starlab. Therefore, we request that hte Starlab be returned to the ROE periodically during the school year. If you could drop off the Starlab after your use no later than 4:15 on Thursday or pick it up Monday afternoon, please mark below.
Pick up and Drop off of Starlab
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Pick up on Monday afternoon from the ROE
Drop off on Thursday at the ROE
I will not be able to pick it up after Monday or drop it off on Thursday
Questions Email: julie.cox@riroe.com
Signature
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Professional Development Registration Form
Name
First
Last
IEIN (number)
*
IEIN (Illinois Educator Identifying Number) is found in the upper left-hand corner of the screen on ECS . All Illinois Certified teachers have an IEIN number. If you do not know your IEIN number, it can be found using the Educator Certification System (ECS) You can either create an account or use the Educator Search (search for yourself and look at "Current Credentials" to find IEIN #)
School District Name and Number
Building
School Phone
Position
Teacher
Administrator
Other
If other, please explain:
Home Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Grade Level/Subject
Email Address
*
Home Phone
Workshop ID Number
*
Workshop Title
Please use the space below for questions or special requests.
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