PTO-MTIP-001 Application 2023

1. MTIP application form

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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 Master Teacher in Intellectual Property (MTIP) 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:
                                                                                                                                                                                                                                                                                                                                                                                                                    

State Selector

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 MTIP, I agree to attend all sessions during the week of July 16-July 21, 2024, and will make reasonable efforts, where applicable, to incorporate the lessons learned during MTIP 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 MTIP 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 MTIP: (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 Master Teacher in Intellectual Property Program, which will take place during the week of July 16-July 21, 2024. (Please limit your response to 250 words or less). Please include your interest, experience, and motivation for applying to NSTI. For more information, please visit our MTIP 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 MTIP
 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 250 words 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:
                                                                                                                                                                                                                                                                                                                                                                                                                    

State Selector

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 MTIP 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

 Social Media (e.g., Facebook, Twitter, LinkedIn)

Identify the social media page: _____________________________________
 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

 Government Agency

Identify program or agency: ________________________________________________
 Teacher Conference

Identify conference and session speaker or topic: __________________________
 Attendance at a previous USPTO event

 Other (please specify) _________________________________________________________

 

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PRA Statement of Burden

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0077. Public burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email InformationCollection@uspto.gov.

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.