Workshop Registration

Confirmation deadline is January 24

This workshop is by invitation only.


Complete the following form and click on SUBMIT to confirm your registration.

You must complete this form in one sitting; you cannot save a portion and return to fill out the rest later. We'd encourage you to compose your answers to the longer questions in a word processor and to cut and paste the resulting text into this form.

Be sure to click SUBMIT when you are done. Remember that you will not be able to alter your registration information via this form once you have submitted it, so please be sure you have completed all fields before submitting.


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(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 will also be our primary means of communication with you.)






We are committed to providing universal access to our programming and supporting special accommodation requests to the best of our ability. Please check the box below if you would like a member of the SERC staff to follow up with you to assist with accommodations that support your needs. Advance notice is necessary to arrange accommodation requests.


In confirming my registration for this workshop, I agree that any images (still or video) made of me during the workshop may be used on the project website, in printed project publications, and in materials developed by the project. I further agree that my contributions to creative works that emerge from workshop activities (e.g., discussions on the email list, contributions to the web page, summaries of group discussion, etc.) may be used by the project, PIs, and conveners for development of future workshop materials, for scholarly reports, and for promotion of the project. Attribution for original contributions will be made whenever possible.




As part of evaluating this workshop we are analyzing information submitted through surveys. We appreciate the time and reflections on what worked, what needs improvement, and what you learned from the leadership development activities. Your input is valuable to us as we plan future programming. The SERC evaluation team will take care to ensure that any information you provide in roadcheck and end-of-event workshop surveys that could identify you is not shared with project leaders.

There are no known risks associated with participation in these surveys. Participation is voluntary. You may discontinue your participation at any time. Identifying information in the form of your name and IP address will be replaced with codes and a datafile linking identifying information and codes will be stored in a separate, secure location. All findings will be presented in aggregate and in a manner that ensures the confidentiality of responses; your name will not be linked to any of your responses.

If you have any questions about this research project, please contact Dr. Ellen Iverson, Director for the Science Education Resource Center (SERC), at eiverson@carleton.edu. The chair of the Institutional Review Board at Carleton College (Anita Chikkatu) can be reached at 507-222-4877 or 1 N. College Street (1-SOAN), Northfield, MN 55057.




The funding agency and participating institutions are committed to maintaining a community where all individuals who participate can work and learn together in an atmosphere free of harassment, exploitation, or intimidation. For full information including independent monitors to report occurrences or concerns see the Code of Conduct. (opens in a new window)

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The following information will be reported only in aggregate. We collect these data for our reports to the National Science Foundation, which funds this project. You are welcome to skip any of these questions if you prefer not to answer them.

Gender Identity (select all that apply):








Which of the following racial or ethnic groups do you identify with? Please select all that apply:













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