Event Registration

Participant InfoFirst Name:

Last Name:

Institution

Campus, if applicable

Department

Email Address:

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Do you have a disability, food allergy, or preference that requires accommodation at the event? If so, please describe:

Position InformationWhich best describes your position?

Full-time permanent instructor
Full-time temporary instructor
Adjunct instructor at one institution
Adjunct instructor at multiple institutions
Non-instructional position
Student

Other position:

How many years of college teaching experience have you had since graduate school?

0-3 years
3-10 years
More than 10 years
Not Applicable

In what fields do you teach? Please check all that apply. If you are a student, in what fields do you take classes?
Astronomy
Atmospheric Science, including Meteorology
Earth System Science
Environmental Policy/Studies
Environmental Science
Geography, Human
Geography, Physical
Geology
GIS
Oceanography
Other fields:

Demographics

The following information will be reported only in aggregate.

Gender:

Female
Male
I do not self-identify as either male or female
I prefer not to answer

Ethnicity (choose one):

Hispanic or Latino
Not Hispanic or Latino
I prefer not to answer

Race (select one or more, or leave all boxes blank if you prefer not to answer):
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Do you currently have a disability?

No
Yes
I prefer not to answer

Are you a veteran or member of the armed forces?

No
Veteran
Currently serving in armed forces
I prefer not to answer

SAGE 2YC

Faculty as Agents of Change

Event Registration