Workshop Application Form

Workshop Application Form

The National Science Foundation provides funding for the operational costs of the workshop plus room, board, and workshop materials for the participants. To be supported by these funds, participants must be either a US citizen, a permanent resident, or in the employ of a US institution. If you don't meet these requirements and are interested in participating in a workshop at your own expense, please contact the workshop conveners.

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

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.

Contact Information
First Name:
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Last Name:
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Department:
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Institution:
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Address:
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City:
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Select a State:

Zip Code:
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Phone:
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FAX:
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Email Address:
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Confirm Email Address:
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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.) Question SetQuestion 1
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Question 2
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Question 3
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DemographicsGender:
Male
Female
Ethnicity (choose one):
Hispanic or Latino
Not Hispanic or Latino
Race (select one or more):
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Disability status (select one or more):
Hearing Impairment
Visual Impairment
Mobility/Orthopedic Impairment
Other
None
Citizenship (choose one):
U.S. Citizen
Permanent Resident
Other non-U.S. Citizen
Number of years of full-time teaching experience:
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Number of years teaching at the college level:
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Current position:
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Discipline:

or Other discipline:
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Will you teach next fall at an institution that serves a large number of minority students?:
Yes
No
Which of the following best describes the department or program in which you will teach next fall:
Two year college (Associate is the highest degree)
Private four-year primarily undergraduate (BS or BA is the highest degree)
Public four-year primarily undergraduate (BS or BA is the highest degree)
Masters granting (MS is the highest degree)
Doctoral granting (PhD is the highest degree)
How did you learn about this workshop?
e-mail announcement
mailed brochure
browsing the Internet
link from the NAGT web site
word of mouth
other
If there is other information relevant to your application, please let us know here:
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