application DOC by HC120929105343

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									                                                 Science Outside the Lab
                               A science policy immersion program in Washington, D.C. for graduate students

                                                    2012 Application – Page 1

Please complete the information below using the Word form feature.                            Date:



Last Name                                                          First Name                                               MI


Mailing Address                                                         City                                   State        ZipCode


Email Address                                                      Cell Phone                            Other Phone


University                                                                  Department


Degree                        Major                                               Term/Year Started            Graduating Term/Year


Session Preference (check one):

                 For Students studying Science Policy, STS or HPS - June 4 through June 15

                 For Students studying in Science or Engineering Fields - June 18 to June 29



Fee Options (check one):
             Option 1 (with lodging): $3,500, includes all program activities and materials, shared lodging for 13 nights, 13 breakfasts,
             10 weekday lunches, and local transportation via the metro while in Washington, D.C. Participants are responsible for
             making their own travel arrangements to and from Washington, D.C., as well as their own lunches during the weekend and
             all dinners.
             Option 2 (no lodging): $2,500, includes all program activities and materials, 10 weekday lunches, and local transportation
             via the metro while in Washington, D.C. Participants are responsible for making their own travel arrangements to and from
             Washington, D.C., and making their own lodging arrangements for the duration of the program, as well as their own
             lunches during the weekend and all dinners.

How will the fees be paid? (grant money, PI funding, self funding, etc.)


COMPLETE THE QUESTIONS ON PAGE 2.




     Please send your completed application by e-mail as an attachment to Andra.Williams@asu.edu or by fax to (480) 727-8791
                                                       by April 2, 2012.
                         For program information, please visit http://www.cspo.org/outreach/scienceoutsidethelab/.
                                              Science Outside the Lab
                            A science policy immersion program in Washington, D.C. for graduate students

                                                 2012 Application – Page 2

Last Name                                                      First Name                                              MI


1.    Briefly explain your career goals and how you see an increased understanding of science policy will help you achieve them
     (1 to 2 paragraphs):




2.   Please provide a two-paragraph biography:




      Please send your completed application by e-mail as an attachment to Andra.Williams@asu.edu or by fax to (480) 727-8791
                                                        by April 2, 2012.
                       For program information, please visit http://www.cspo.org/outreach/scienceoutsidethelab/.

								
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