Name:

School:

Your role and responsibility in the school:

Years of Teaching Experience:

Telephone:

Email:

Address:

To Know You Better

1. Please list five words that you would use to describe yourself:

a.

b.

c.

d.

e.

2. What is the one change that you have been working on in the last 2 years in your classroom/school? What has worked for you? What are the challenges you are facing in bringing the desired change?

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3. What are the three most important challenges that you face as an educator?

4. How are you feeling about attending the learning Expedition for Educators?

a. Nervous b. Not sure c. Ok d. Ready e. Excited

5. What are the things that you are looking forward to in the Learning Expedition?

6. What would you like to know more about the Learning Expedition?

Payment Details

Cheque No. / Demand Draft No.:

Bank:

Amount (Rupees):

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Please mail the registration form along with the cheque/ demand draft to Disha India Education Foundation; Cheque/ demand draft should be in favour of ‘Disha India Education Foundation’ payable in Gurgaon. • Last date of Registration:14 th August 2017. • Cancellations till 31st August, 2017 carry no charge. 50% of the fee paid will be charged on cancellation after 31st August, 2017 • You may use photocopies of this form for multiple registrations.  • On registration, you will receive a detailed schedule and travel plan.

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Please mail the registration form along with the cheque/ demand draft to Disha India Education Foundation; Cheque/ demand draft should be in favour of ‘Disha India Education Foundation’ payable in Gurgaon. • Last date of Registration:14 th August 2017. • Cancellations till 31st August, 2017 carry no charge. 50% of the fee paid will be charged on cancellation after 31st August, 2017 • You may use photocopies of this form for multiple registrations.  • On registration, you will receive a detailed schedule and travel plan.

Please mail the registration form along with the cheque/ demand draft to Disha India Education Foundation; Cheque/ demand draft should be in favour of ‘Disha India Education Foundation’ payable in Gurgaon. • Last date of Registration:14 th August 2017. • Cancellations till 31st August, 2017 carry no charge. 50% of the fee paid will be charged on cancellation after 31st August, 2017 • You may use photocopies of this form for multiple registrations.  • On registration, you will receive a detailed schedule and travel plan.