SERC > SERC Workshop Module Template > Application
Below you'll find an example of a workshop application form. You'll want to work with SERC staff to develop an application form appropriate for your workshop. You can download a .doc version (Microsoft Word 176kB Jul17 09) of this form to markup and use in communicating what you want for your form.

Complete the following form and click on SUBMIT to complete your application. Be sure to hit the SUBMIT button before leaving this page or your information will be lost. We 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. This gives you access to conveniences like spell checking as well as the opportunity to save and reflect on your work before submitting.

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

Contact Information

(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. Please double-check that you have typed it correctly.)
Question Set


Race (select one or more):

Disability status (select one or more):

*Please type the two distorted words into the box below. Separate them with a space. This helps us prevent spam. For more details or help click the question mark.