Department of Metallurgical and Materials Engineering - HBCU

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Application Form

Late registrants will be added to a waiting list

IDENTIFICATION


First Name:*	Last Name:*	MI:

ADDRESS


Home Address:*	HomeTelephone:

	Home Fax:
City:*
State:*
Home Zip Code:*
Work Address:	Work Phone:
	Office Fax:
City:
State:
Work Zip Code:

Work E-mail:*	Other E-mail:

PROFESSIONAL INFORMATION


Title:*	Institution:
Department:
Degree(s):	Discipline:	Year Earned:






Years in Teaching:
Years at Current Institution:

What is the level of your exposure to the field of materials science and engineering?*

None

Limited

Significant

Extensive

Explain?:

Courses Taught in the Last Two Years:

Course Title:	Year:	Semester:	Level(Freshman,etc):

Any Special Dietary Requirements:
(The purpose of us knowing this information is for our ordering the menu for the Orientation Dinner, and the Farewell Luncheon.)

No special requirements

Vegetarian

Kosher

Food Allergies

List food allergies:

What do you expect to gain out of attending this seminar?
(Explain how you think this will help your curriculum and/or institution and how you will use it in your teaching?)

I AGREE TO PARTICIPATE IN ALL ACTIVITIES OF THE THREE-WEEK WORKSHOP.


Phone: 205-348-1740 Fax: 205-348-2164	© 2004 The University of Alabama Department of Metallurgical and Materials Engineering Box 870202 Tuscaloosa, AL 35487-0202	Webmaster Disclaimer