I. Contact Information
|
|
II.Education and Department Information |
| Field of study: |
|
| Projected graduation date: |
|
| Highest degree offered at your institution: |
|
| How many faculty members in your department: |
|
|
| Is there a Women in Science and Engineering Program or similar group on your campus?
|
| If so, how often do you attend events? |
|
|
|
III. Personal Statements |
| Please explain in the space provided why you would like to attend this conference and what you would expect to get out of it? (250 word maximum) |
|
|
IV. Research Presentation (Optional) |
Participants have the opportunity to give a 10-15 minute oral presentation of research or present research in a poster session. Presenting research is optional and is not a factor for acceptance as a participant. Participants who present will be given guidelines for preparing their oral and poster presentations.
Would you like to present research that you have done as an undergraduate?
|
|
|
| Possible title of poster or presentations? |
|
|
V. Estimated Travel Expenses |
| We encourage you to ask your department for funding for travel. Travel grants are available for participants. The amount awarded to each participant will depend on the total amount requested by all participants. |
| Method of travel |
|
| Estimated travel cost |
|
| Driving Distance |
|
| Your department is willing to contribute
|
|
|
VI. Accomodation Information |
| Accommodations will be provided for participants on Friday and Saturday evenings, if required. There will be two participants per room. On campus parking will be provided for participants not staying at the hotel. |
I would like accommodations for the following nights: |
|
If you know someone else who is coming, with whom you would like to share a room, please enter her name:
|
Meals will be provided from breakfast on Saturday through an afternoon snack on Sunday. Do you have any dietary restrictions?
|
|
|
VII. Notes |
If you would like to clarify any of the above questions, please add your notes here: |
|
Once you submit this application form, you will be directed to a survey sponsored by the conference organizers. The purpose of this survey is to assess your experiences of and attitudes about studying physics at the undergraduate level as well as your career goals. The survey is completely anonymous. No one analyzing the data will have access to your name. While your participation is entirely voluntary, we hope to have the broadest possible participation; thus, your individual contribution is extremely important to the success of this effort. All information obtained through this survey will be kept strictly confidential. None of the conference organizers will have access to the individual responses, and all results will be reported in a summary form. Your responses to this survey will not be used to determine conference eligibility.
In order to compare responses to this pre-conference survey to a post-conference survey (to be provided to participants after the conference), we ask that you please provide a unique identifier in the field below, to include your mother’s initials and your own birthday (mmddyy) – e.g., sr010180 or skr010180 (the latter includes a middle initial, which may be included or omitted).
Again, you should be automatically directed to the survey once you click the submit button. Please contact Keith Rainwater (ktexas@umich.edu) should you experience any problems.
Unique Identifier
|
|
|
