Workshop Application Form

The deadline for this application is March 8, 2013. Workshop space is limited.

If you are accepted for the workshop, you will be asked to complete a registration form to provide us with more information.

The National Science Foundation provides partial funding for some of the operational costs of the workshop plus room, board, and workshop materials for the participants. To be supported by these funds, participants must be either a US citizen, a permanent resident, or in the employ of a US institution. If you don't meet these requirements and are interested in participating in a workshop at your own expense, please contact the workshop conveners.

Complete the following form and click on SUBMIT to send us your application. Be sure to hit the SUBMIT button before leaving this page or your information will be lost.

Please direct any questions you have regarding this application to Heather Macdonald.

Contact InformationFirst Name:

Last Name:

Institution:

Department:

Address:

City:

Select a State:

Zip Code:

Phone:

FAX:

Email address:

Confirm your email address:

(Please Note: Your email address is what we use to track your application and participation in the workshop. Be sure to use the same email address in all forms relating to your workshop participation. This email address will also be our primary means of communication with you. Please check that you typed it correctly.)

Workshop Interests and Expertise
In what ways do you hope to benefit from the workshop and what do you hope to learn?

What will you be able to contribute to the workshop?

Current Position

Graduate student
Post-doctoral researcher
Other

If other, please give current position:

Highest degree awarded:

Date awarded:

Institution from which highest degree was awarded:

Degree in progress (if applicable):

Anticipated degree completion date (if applicable):

Institution for anticipated degree (if applicable):

When do you anticipate applying for a position in the academic environment?

<1 years
1-2 years
>2 years

Statement of Endorsement

Please arrange to have a faculty member submit an endorsement of your application using the online form no later than March 8, 2013. When you make those arrangements, please give the email address you use on the workshop application form to the faculty member writing your endorsement letter. We use that email address to track all of your application materials, so if they submit a letter for you with a different email address, we won't know to connect it to your application.

Please provide us with the contact information for the faculty member who has agreed to provide this information in support of your application.

Faculty name:

Faculty institution:

Faculty email address: