1. Application Information

 
10% of survey complete.

Thank you for expressing interest in the COSEE-OS Educator-Scientist Collaborative Workshop being held at the University of Connecticut on October 9-10.

Please fill out the following application information. In addition, we ask that you please complete the brief questionairre following the application. Your information will be used to match you with a research scientist based on your interests, and will also be used to evaluate what you gained from attending this workshop.

Application deadline is August 31, 2009.

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* Please provide some basic demographic information (this information will not be shared).

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* Please provide your phone number (This information will not be shared it is for contact purposes only)

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* Please provide some basic information about your organization/center or school.

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* What is your gender?

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* What is your race/ethnicity? Please check all that apply:

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* Is there anyone planning to attend the workshop that you would prefer to work with in a small group?
If so, please list their name here.

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