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1. NMNEN 2010 Workshop Registration


This workshop is jointly sponsored by a CCLI Phase I award (#0633736) from NSF DUE and CINT

Thank you for your interest in NMNEN,

Boris Kiefer, Vicente Lombrana, Elba Serrano

* 1. NAME

* 2. POSITION

* 3. CONTACT EMAIL

* 4. CONTACT PHONE

* 5. DEPARTMENT (STUDENTS, IF NOT EMPLOYED, STATE YOUR MAJOR)

* 6. INSTITUTION

* 7. MAILING ADDRESS

8. Please select the row and column that best indicate your intended participation.

  I will submit materials for dissemination I will NOT submit materials for dissemination
I will attend
I might attend
I will not attend

* 9. STATUS:PLEASE SELECT ALL THAT APPLY

* 10. STUDENT STATUS:PLEASE SELECT ALL THAT APPLY

* 11. Please indicate all your degrees

* 12. Please provide a brief bio (50-150 words) for the program

* 13. Briefly describe your interest in nano(bio)science education.

* 14. Briefly describe the materials you will share with other participants.

* 15. COURSE OFFERINGS: Which COURSES do you offer? Please select all that apply (Students, select n/a if you have not offered a course)

  elementary school students middle school students high school students lower division UG students upper division UG students graduate students online students faculty n/a
biology COURSES for
physics COURSES for
nanoscience (no life science emphasis) COURSES for
nano(bio)science COURSES for
research/scientific ethics COURSES for
other STEM courses not listed above

* 16. BACKGROUND: Which COURSES or WORKSHOPS have you taken in the following areas?

  lower division UG students upper division UG students graduate students online students faculty n/a
biology for
physics for
nanoscience (no life science emphasis) for
nano(bio)science for
research/scientific ethics for

* 17. PLEASE SELECT ALL THAT APPLY

18. OPTIONAL DEMOGRAPHIC DATA. Select any that apply to you and that you wish to provide to us.

19. If available, Please provide a link to your web page.

* 20. How did you hear about the workshop? Please select all that apply

* 21. How long did it take to complete this form?

* 22. DATE

Today's date
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