z Active LENS Train-the-trainers Workshop, 2019 Edition-Application Form Posted on 2019-01-20 by Diane Blackwood Active LENS Train-the-Trainers Workshop #5 If you have any difficulties, please email Mike Wiser (mwiser@msu.edu) for assistance. Active LENS Train-the-Trainers Workshop #5 Please note that this form must be completed in one sitting. The process may NOT be started, saved, and returned to at a later time. If you are applying as a single individual, please either write "same as above" or enter your information for both the 1st and 2nd team member entries. Which workshop are you interested in?* June 12-14, Austin, Texas August 7-9, East Lansing, Michigan Either (gives greatest chance of acceptance) If you are interested in both workshops, which would you PREFER?*Select a preferenceNo preferenceJune 12-14, Austin, TexasAugust 7-9, East Lansing, MichiganCONTACT INFORMATION - 1st Team MemberThe following set of questions is set up primarily for applicant pairs. If you are applying as a single individual, please enter your own information for both applicants.Name*Job Title and/or Academic Rank*Institution*Department*Campus Address*City/State/Zip/Country*Work Phone Number*Email Address* Please provide an email address for pre-workshop correspondence.PERSONAL INFORMATION - 1st Team MemberAcademic or personal website On a scale of 1 to 5, with 1 being low and 5 being high, please rate your familiarity with evolutionary theory.*12345On a scale of 1 to 5, with 1 being low and 5 being high, please rate your familiarity with Avida-ED*12345Please indicate your sex.*MaleFemaleChoose not to respondPlease indicate your ethnicity or racial background.*Caucasian/WhiteBlack/African AmericanLatino/HispanicAsianAmerican Indian/Alaskan Native/Native Hawaiian/Pacific IslanderTwo or more racesChoose not to respondPlease indicate your highest completed education level.*Baccalaureate (BA, BS)Masters (MA, MS)Doctoral (PhD, EdD)Professional (MD, DVM, PharmD)Please indicate your discipline or professional field.*Please indicate the number of years your have been teaching*Fewer than 5 years5 - 10 yearsMore than 10 yearsDo not teachPlease indicate the type of position you currently hold*TenuredPre-tenureFixed-term/Renewable contractGraduate Student/PostdocNot employedChoose not to respondPlease indicate the percentage of your professional activity dedicated to the following: Teaching, Research, Service, and Other (please specify)*SAMPLE: 48% teaching, 40% research, 12% service, 0% otherPlease indicate the primary type(s) of students you teach (up to two choices)* Undergraduate students - biology/health majors Undergraduate students - other STEM majors Undergraduate students - general education or non-science majors Graduate, medical or professional students Pre-service or in-service teachers High school students Do not teach Other: If other, please specify:Please indicate the primary delivery system you use for teaching*Only face-to-face coursesOnly online coursesCombination of online and face-to-face coursesDo not teachINSTITUTIONAL INFORMATION - 1st Team Member If you teach at a university, college or community college go to the Carnegie Foundation site . Click the Institutional Lookup menu and then search for your institution by name. Click the link that appears to get the Carnegie Foundation information page for your institution. If you teach at a high school, fill these out based on your school profile. Carnegie Classification: Institution Name*SAMPLE: Michigan State UniversityCarnegie Classification: Control*SAMPLE: PublicCarnegie Classification: Size and Setting*SAMPLE: L4/R: Large four-year, primarily residentialCarnegie Classification: Basic Classification*SAMPLE: RU/VH: Research Universities (very high research activity)Upload curriculum vitae/resume, limited to two pages.*Accepted file types: doc, docx, pdf, rtf.Please name the file with lastname_firstinitial_CV. Maximum file size: 8MB. Allowed file extensions: .doc, .docx, .pdf, .rtfUpload application letter (no more than 3 pages double-spaced)*Accepted file types: doc, docx, pdf, rtf.See above for the list of topics you must address in your letter. Please name the file with lastname_firstinitial_letter. Maximum file size: 8MB. Allowed file extensions: .doc, .docx, .pdf, .rtfHow did you hear about this workshop? Please be as specific as possible; for example, if you heard about this through a mailing list, which list? If you heard about this from a workshop, which workshop?*CONTACT INFORMATION - 2nd Team MemberName*Job Title and/or Academic Rank* Institutional information same as applicant 1 InstitutionDepartmentCampus AddressCity/State/Zip/CountryWork Telephone Number*Email* PERSONAL INFORMATION - 2nd Team MemberAcademic or personal website On a scale from 1 to 5, with 1 being low and 5 being high, please rate your familiarity with evolutionary theory:*12345On a scale from 1 to 5, with 1 being low and 5 being high, please rate your familiarity with Avida-ED:*12345Please indicate your gender*MaleFemaleChoose not to respondPlease indicate your ethnicity or racial background*Caucasian/WhiteBlack/African AmericanLatino/HispanicAsianAmerican Indian/Alaskan Native/Native Hawaiian/Pacific IslanderTwo or more racesChoose not to respondPlease indicate your highest education level*Baccalaureate (BA, BS)Masters (MA, MS)Doctoral (PhD, EdD)Professional (MD, DVM, PharmD)Please indicate your discipline or professional field.*Please indicate the number of years your have been teaching*Fewer than 5 years5 - 10More than 10 yearsDo not teachPlease indicate the type of position you currently hold*TenuredPre-tenureFixed-term/Renewable contractGraduate Student/PostdocNot employedChoose not to respondPlease indicate the percentage of your professional activity dedicated to the following: Teaching, Research, Service, and Other (please specify)*For example: 48% teaching, 40% research, 12% service, 0% otherPlease indicate the primary type(s) of students you teach (up to two choices)* Undergraduate students - biology/health majors Undergraduate students - other STEM majors Undergraduate students - general education or non-science majors Graduate, medical or professional students Pre-service or in-service teachers High school students Do not teach Other If other, please specify:Please indicate the primary delivery system you use for teaching*Only face-to-face coursesOnly online coursesCombination of online and face-to-face coursesDo not teachINSTITUTIONAL INFORMATION - 2nd Team Member If you teach at a university, college or community college go to the Carnegie Foundation site . Click the Institutional Lookup menu and then search for your institution by name. Click the link that appears to get the Carnegie Foundation information page for your institution. If you teach at a high school, fill these out based on your school profile. Carnegie Classification: Institutional NameSAMPLE: Michigan State UniversityCarnegie Classification: ControlSAMPLE: PublicCarnegie Classification: Size and SettingSAMPLE: L4/R: Large four-year, primarily residentialCarnegie Classification: Basic ClassificationSAMPLE: RU/VH: Research Universities (very high research activity)Curriculum Vitae/Resume, limited to two pages*Accepted file types: doc, docx, pdf, rtf.Please name the file with lastname_firstinitial_CV. Maximum file size: 8MB. Allowed file extensions: .doc, .docx, .pdf, .rtf Letter (no more than 3 pages double-spaced*Accepted file types: doc, docx, pdf, rtf.See above for the list of topics you must address in your letter. Please name the file with lastname_firstinitial_letter. Maximum file size: 8MB. Allowed file extensions: .doc, .docx, .pdf, .rtfHow did you hear about this workshop? Please be as specific as possible; for example, if you heard about this through a mailing list, which list? If you heard about this from a workshop, which workshop?*Questions about the application process should be directed to Michael Wiser, Research Associate, mwiser@msu.edu.Untitled UntitledPost Title
