Last Name:
First Name:
Institution:
Preferred mailing address:
Alternate mailing address: (May 1-June 30):
Office phone: home phone:
fax:
Your email address (required):
Gender: male female
Citizenship (select one):
U.S. Permanent Resident country of origin:
Non-U.S. Citizen country of citizenship:
Visa/Immigration status:
U.S. Citizens and Permanent Residents: this
question is
optional, but helpful in assessing efforts to attract a diverse group of participants
(select one):
How did you hear about PCMI? (select one)
If advertisement, please specify publication:
Will you be able to attend the entire PCMI program?
(June 29 - July 19, 2003) Yes
No
If not, please specify dates you can attend:
(Attending the entire session is encouraged for all
participants. Graduate students, undergraduate students, and high school teachers
who receive financial support from PCMI are expected to attend the entire three-week
session.)
Financial Information
Financial Support requested from PCMI: (check all that apply)
Travel Lodging Meals
Funding provided by applicant’s institution: (check all
that apply)
Travel Lodging Meals
ACADEMIC INFORMATION
Current Position:
Nontenured FacultyTenured Faculty
Date of PhD:
Graduate Institution:
Do you currently have NSF funding or other US Government
support?
If yes, describe briefly:
Have you ever directed graduate or undergraduate students
in mathematics research, or do you have plans for such activity?
If so, please describe
them briefly:
Please give a brief description of your current teaching
interests.
Please list titles of recent preprints and publications
(no more than five). You may send the abstract and reference pages from one preprint with
this application form.
CAREFUL ANSWERS TO THE FOLLOWING QUESTIONS WILL INFLUENCE
YOUR CHANCES OF ACCEPTANCE.
1) Are there any topics you would like to see discussed in
the organized afternoon sessions or Working Groups?
2) An important part of PCMI’s mission is the
integration and interaction of all participants. There will be six groups present at the
Summer Session: undergraduate students, graduate students, high school teachers,
undergraduate faculty, and researchers in both mathematics and in mathematics education.
There will be four all-Institute programs each week designed to be of interest to more
than one of these groups and, ideally, of interest to them all. Are there any topics of
special interest to you that we might include in these all-Institute programs?
3) Do you have any suggestions for projects that would
involve participants from more than one of the groups? We are especially interested in
activities that would involve undergraduate students and/or high school teachers, but
other connections would also be of interest.
4) Are you currently involved in any curriculum
development projects, or do you have plans for such activities? If so, please describe
them briefly.
5) Please list any education projects you have been
involved with (at any level). Also list any other information that would have a bearing on
your participation at the Institute.
6) Please write a one-page or less personal statement describing what you
hope to accomplish at the PCMI’s Summer Session. Feel free to describe more than one
goal.
