Application

Personal InformationFirst Name:

Last Name:

Institution:

Department:

Email Address:

Confirm 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 will also be our primary means of communication with you. Please double-check that you have typed it correctly.)

Which of the following best describes your role at the institution listed above (please select all that apply)?
Professor
Associate Professor
Assistant Professor
Instructor/Lecturer
Adjunct/Visiting Faculty
Postdoc
Graduate student
Staff
Undergraduate Student
Informal Educator
K-12 Teacher
Researcher
Administrator
Other
Please specify:

How many years have you attended/worked at the institution listed above?

What is your primary subdiscipline?

Participant Stipends

To help offset costs of attending the workshop and lodging the night before the workshop, stipends are available from the NSF grant for eligible participants. Participants can receive a $450 stipend and book their own lodging for the night of Wednesday, October 18th, or participants can request GSA book their Wednesday night lodging at the Omni William Penn Hotel and receive a $200 stipend. Please select one of the check boxes below:

I prefer the $450 stipend and I will book my own lodging for Wednesday night.
I prefer the $200 stipend and I would like GSA to book my lodging for Wednesday night.
I am not eligible to receive a stipend.

Question SetWhat are you hoping to gain from participating in this workshop?

What are you hoping to contribute to the workshop and what experiences or materials do you hope to share?

What is your commitment to, or experience with, accessibility, belonging, inclusion, diversity, and equity (ABIDE) in the geosciences?

What are some aspects of mental health you think are especially important for the geoscience community to address?

If there is other information relevant to your application, please let us know here:

Demographics

We are asking for this demographic information because our goal is to have overrepresentation of participants from historically excluded, minoritized backgrounds (at least 50% of attendees not counting White women) in the workshop. We will also report the anonymized demographics of applicants vs. attendees to NSF in our annual report. Only the application review committee will have access to this information, and your responses will be kept private and secure.

Race/ethnicity
Self-describe:

Gender identity
Self-describe:

Disability status
Self-describe:

Sexual orientation
Self-describe:

Application

Application deadline has been extended to Friday, September 22th