2013 SI Participant Application SF-1.doc - National Academies

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2013 SI Participant Application SF-1.doc - National Academies Powered By Docstoc
					                                                                                     National Science Foundation
      Summer Institute

                         National Academies Summer Institute @ West Virginia University
                                    June 2-7, 2013 • West Virginia University

                                                 2013 Participant Application

                             Submit one copy of this form for each member of the team.
                       Each participant must also submit a current biosketch of 2 pages or less.1

Participant Name:                                 Title/Position:
Department:                                       Institution:
Mailing Address:
Phone:                                   Fax:                         E-mail Address:

List the course(s) you expect to teach during the 2013-2014 academic year, the anticipated enrollment(s), and
if the course(s) is designed primarily for majors, non-majors, or both. Also describe your role in the course
(e.g., course head, only instructor, one of a team).

                                              Majors, Non-         Anticipated      Your Role
Name of Course(s)                             Majors or Both       Enrollment       (Head/Only Instructor/One of a Team)

                                                                                       Head;       Only;   One of team

                                                                                       Head;       Only;   One of team

                                                                                       Head;       Only;   One of team

Please check the disciplinary group below that you would like to work in at the institute. Each group will
develop instructional materials to be taught in one of their courses during the 2013-2014 academic year. If
you prefer to work in an interdisciplinary group, please check that box, plus the boxes of the disciplines you
wish to bridge. Please list a topic that you would prefer also.

          Biology      Chemistry      Math      Physics    Interdisciplinary (check also the disciplines to bridge)
       List topic[s] within the major discipline that you would prefer to work on:

    Please use the format suggested by the National Science Foundation for submission of proposals. See
                                                                                       National Science Foundation
   Summer Institute

I agree to:
     Teach one or more of the instructional materials developed at the Summer Institute in a course that I
         teach during the 2013-2014 academic year.
     Coordinate a seminar, workshop or brownbag session on what you learn at the summer institute for
         graduate students, postdocs, or faculty at your home institution, during 2013-2014
     Participate in evaluation of the Summer Institute.
     Stay for the entire Summer Institute.

Signature _________________________________________                                          Date __________________
           Sending by or cc’ing participant will be considered a valid signature if submitting electronically

Completed applications may be submitted electronically or in hard copy. (Please do not send both electronic
and hard copies of the same application.) If possible, all parts of the application (Cover Page and
Participant Application Form) should be submitted together (single PDF preferred). Submission methods:
       E-mail attachment (PDF, Word, or RTF) to michelle.withers@mail.wvu.edu
       Hard copy to: Michelle Withers, 53 Campus Drive, 3139 LSB, Biology Dept., WVU, Morgantown,
        WV 26506
       Fax to 304-293-6363

All application materials must be received by April 15, 2013, for full consideration.

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