UMass Lowell TUES Performamatics Project : Workshop Application Form

Workshop participants are required to attend in interdisciplinary pairs, preferably from the same institution. This will ensure that the workshop itself models interdisciplinary collaboration and produces outcomes that connect directly to participants’ own situations.

We welcome professors and instructors from 2- and 4-year colleges and universities. High school teachers should contact the instructors to attend by special arrangement.

Please complete the form below as best you can. Questions should be directed to Jesse Heines at Jesse_Heines@uml.edu.

Fields marked with an asterisk are required.

Which workshop do you wish to attend? * One day: April 27, 2012, 9:00 AM to 3:00 PM, at UMass Lowell in conjunction with ASEE-NE COMPLETED Two day: June 21-22, 2012, 9:00 AM to 5:00 PM, at UMass Lowell SORRY ... ALREADY FULL! Two day: January 17-18, 2013, 9:00 AM to 5:00 PM, at UMass Lowell Please choose one.
Please tell us about yourself...
Your Full Name	*
Institution	*
Department	*
Email Address	*
Phone Number	*	Work	Cell
Website URL
Courses You Teach	*
Please state briefly why you would like to attend this workshop.	*
Please tell us about the other member of your pair...
His or Her Full Name	*
Institution	*
Department	*
Email Address	*
Phone Number	*	Work	Cell
Website URL
Courses He or She Teaches	*
Are you requesting support for travel? * Yes No Please choose one. Travel support is only available for two-day workshops.
Please tell us how you heard of this workshop...
How or where did you hear about this workshop?	*

Fields marked with an asterisk are required.

Which workshop do you wish to attend? *

Please tell us about yourself...

Please tell us about the other member of your pair...

Are you requesting support for travel? * Yes No Please choose one.

Please tell us how you heard of this workshop...