First Name

Last Name

E-mail

Webpage

Affiliation

Position

Check which type of track:
CAPP-E (Education)    CAPP-R (Research)    CAPP-L

For Academia:

Department

Date of Tenure

Date of Promotion
to Associate Professor

For Industry:

Job Title

Date you started to work at your institution

Short Bio (1 paragraph/150 words or less)

Area(s) of Research or Teaching Focus

The seminar gives participants the opportunity to meet individually with the Distinguished Professors. Are you interested?
YES NO UNSURE
If so, please bring a current CV.

We have funding for a reasonable portion of our participants. If you would like to apply for this funding, please provide an estimate of your travel expenses.
We encourage all qualified women to apply regardless of concern for travel expenses.

Any special considerations/circumstances