CSE Workshops 2012
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General Information
*
1
. General Information
General Information
Name:
Current Job Title:
Department:
Institution:
City, State, Zip:
Phone Number:
Fax Number:
Email Address:
Cell Phone Number:
2
. What is your race/ethnicity? (optional and may select multiple categories)
What is your race/ethnicity? (optional and may select multiple categories)
Asian Descendent
Black/African American
Latino/Hispanic Origin
Native American, Alaskan, or Hawaiian
White/Caucasian
3
. Are you tenured?
Are you tenured?
Yes (if yes, list the year granted below)
No (if no, list the year expected below)
Year tenure was granted or expected
4
. Indicate your first and second choices for the breakout group you would like to join during the workshop from the following options:
Indicate your first and second choices for the breakout group you would like to join during the workshop from the following options:
Energy (E)
Materials, Manufacturing, and Design (M)
Structures, Construction, and Infrastructure (S)
Water and Air Resources (W)
5
. Which workshop are you applying to?
Which workshop are you applying to?
Workshop 1 (Jun 4-5)
Workshop 2 (Jun 7-8)
6
. If we are unable to accommodate your preference of Workshop 1 or 2, would you be willing to attend the other workshop?
If we are unable to accommodate your preference of Workshop 1 or 2, would you be willing to attend the other workshop?
Yes
No
7
. In one or two sentences, list your main research and teaching interests.
In one or two sentences, list your main research and teaching interests.
8
. In one or two sentences, describe the course you plan to work on while attending the workshops.
In one or two sentences, describe the course you plan to work on while attending the workshops.
9
. If accepted to one of the CSE workshops, I agree to:
If accepted to one of the CSE workshops, I agree to:
Submit a detailed outline of the educational module I plan to work on during the workshop by April 1, 2012
Submit a completed original educational module on a topic within sustainable engineering to the CSE Electronic Library by May 31, 2013
Review at least one educational module submitted to the CSE Electronic Library
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