Institution:

Preferred mailing address:

Alternate mailing address: (May 1-July 10): 

Office phone: home phone:
Fax:

Your email address (required):

Gender: male      female

Citizenship (select one):
citizenship U.S. Citizen U.S. Permanent Resident Non-U.S. Citizen

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):
Ethnicity (Optional) African American Asian American Caucasian Native American Hispanic

How did you hear about PCMI? (select one) 
how you heard about PCMI Advisor Faculty member Colleague Poster/literature Internet Advertisement

If advertisement, please specify publication:

Will you be able to attend the entire PCMI program? (July 11-July 31, 2004) 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:

a. Graduate Student (please state year graduate studies began)

b. Non-tenured Faculty or Postdoctoral Scholar

Date/expected date of PhD:

Undergraduate Institution:

Graduate Institution:

Name of person who will be sending a letter of recommendation on your behalf:

Thesis title or topic (if known):

If you have/had a thesis advisor, list his/her name:

Advisor's Institution:

Please list your current or potential research interests:

Please list the titles and professors of any courses, seminars, or conferences you have attended that relate to the Graduate Summer School/Research Program topic.

Please list the names of any publications written or honors received.

You may include the abstract and reference pages from one preprint with this application (optional). If so, list the title here:

CAREFUL ANSWERS TO THE FOLLOWING QUESTIONS WILL INFLUENCE YOUR CHANCES OF ACCEPTANCE.

1) Briefly summarize your educational background in combinatorics, topology, geometry and algebra.   Mention texts, advance courses, et cetera.  (The purpose of this question is to help the organizers prepare; lack of advanced training will not disqualify you.)

2) Please outline your teaching experience (you may be asked to serve as a mentor).


3) Would you be interested in joining discussions on how to present geometric and/or combinatorial topics to a high school or undergraduate audience?   Do you have another similar suggestion you would like to carry out?
  

4) 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 several 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?

5) 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.

6) Please write a one-page or less personal statement describing what you hope to learn and accomplish at PCMI’s Summer Session. Feel free to describe more than one goal.

7) Please list any other information that would have a bearing on your participation at the Institute.