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2016 CUWiP Application Form

* indicates required fields.
I am currently an undergraduate student:
(If "No" is selected, the user will be redirected to another page with instructions on how to be considered for attendance.)
Yes    No
I am a current APS member, or a past member, or I have attended an APS meeting in the past and/or last year's CUWiP. (This will help us identify if you already have an APS Member ID.) 
Mermber ID
*First Name:    MI:     *Last Name: 
*Email: 
*Re-type Email: 

Current Postal Address

*Address: 
*City: 
*Country: 
*State:      * Postal Code:
* Address Type:  School      Home

Home Postal Address (If the current address is not home address.)

Home Address: 
City: 
Country:
State:      Postal Code: 

Supplemental Data

*Gender: 
Female      Male      Other (please specify)   
*How did you hear about the conferences? 
(Select all that apply)
APS CUWiP website
Regional CUWiP website
Local Society of Physics Students
National Society of Physics Students
Fellow student
Department chair
A faculty member other than the chair
Other department staff member
A poster
Email solicitation
Other (please specify)  
Other web source (blog, tweet, LinkedIn, etc. – please specify)  

Education and Department Information

*
*Field Of Study: 
*Expected Graduation Date:  (yyyy)
*How many previous CUWiP conferences have you attended? 
*If you have attended a previous conference, which conference(s) have you attended? 
(To select more than one conference, hold down your Control key while selecting the second, third and so forth site that you have attended).
 

Preferred Conference Site

We strongly encourage students to apply to attend the site to which they will be geographically closest during the Martin Luther King Jr. holiday weekend in 2016. In some cases, students may be reassigned to attend either (a) the geographically closest site or (b) the next geographically closest site due to oversubscription at the closest site. Reassignments are made to maximize the total number of participants who can attend; we appreciate your patience with us as we try to accept as many applicants as possible.

If your first choice is not the geographically closest site, you must explain your choice in the comment box.

*Where will you be traveling from to attend the conference (city, state or province)?
 
*Preferred Conference Site: 
 
Explanation of choice, if first choice is not geographically closest site (~ 300 words): Your words: 0
 

Coverage of Conference Travel

We encourage you to ask your department for funding for travel. Travel support is available to participants whose department is unable to provide full funding for travel. (Food and accommodation are provided by the conferences.)
*Have you asked your department Chair to cover your travel costs to the conference?
  Yes  No
*Will your department be able to cover your travel costs?
  Yes  No Partial No travel support needed

*Applicant Statement:

Write a statement describing your educational background, your academic interests and goals, and your objectives in attending a Conference for Undergraduate Women in Physics. (Recommended length: 100 to 200 words.) Your words: 0