Please Note: The information on gender and ethnicity is for statistical purposes only to aid us in reporting to the National Science Foundation. Answers to these questions will not be considered in the selection process.

 

Gender:	Select... Female Male		Ethnicity:	Select... American Indian or Alaskan Black/Afro-American Cambodian, Laotian, or Vietnamese (after 1975) Hispanic Other Asian or Pacific Islander White
Home Telephone:			Work Telephone:
University:			Department:

 

Team ID: (optional)			Shirt Size:	Select... Small Medium Large X-Large XX-Large
Workshop:	Select... Norfolk State University Bethune Cookman University of New Mexico Centennary College Worchester Polytech Institute University of Illinois University of Alabama Birmingham San Diego State University Williamette University Ohio Supercomputer Center University of Arkansas Little Rock Prairie View A&M High Point University Flordia State University Washington University Appalachian State University San Jose State University

What factors influenced your decision to participate in a NCSI workshop (Check all that apply):

	I am interested in using modeling & visualization tools in instruction
	I am interested in using modeling & visualization tools in my own research/lab
	A former participant in a Shodor workshop encouraged me to participate
	Another team member encouraged me to participate
	My department chair encouraged me to participate
	I have participated in similar workshops and found them useful
	I thought it could provide knowledge and leverage for making changes in my department/college
	I wanted the opportunity to meet and network with other instructors who use these tools
	The costs of attending & post-workshop materials are paid for by the NCSI
	The location was convenient or of interest
Other:

For what level or type of course(s) are you interested in using modeling and visualization tools? (Check all that apply):

	Introductory-level undergraduate
	Intermediate-level undergraduate (some prerequisites or background needed)
	Upper-level undergraduate/some graduate students
	Graduate student level
	Independent research
	Returning student/extension courses
	Methods/teacher preparation courses

 

In what disciplinary area is the course(s) in which you plan to use modeling and visualization tools? (Check all that apply):			Please check the statement that best describes the computer access within your course's instructional setting. (If you will be using the tools in more than one course, check all that apply):
	Computer science/Programming			There is a separate computer lab in another building available for class use
	Mathematics			There is a separate computer lab in the same building available for class use
	Engineering			There are one or more computers in my classroom, but not enough for small groups
	Physical Sciences			I have enough computers in my classroom for small groups
	Life Sciences			I have enough computers in my classroom for students to use individually
	Social Sciences			Other
	Education (K-12 teachers)
	Liberal Arts
	Other

 

What level of Internet access do these instructional computers have:			In the course(s) in which you are interested in using modeling & visualization, how frequently do you currently use computers in instruction? (Pick the closest option):
	I don't know			Computers are not currently used
	No Internet access			A few times during the semester
	Dial-up Modem			About once every two weeks
	T-1 line			Weekly
	High speed line/Internet 2			Almost every class period

Please mark the number that represents your current level of expertise in the areas below:

	1(None)	2 (Novice)	3 (Average)	4 (Above Average)	5 (EXPERT)
PC/Mac operation
Electronic Mail
Internet browser use
Numerical research methods and modeling
Computer Programming
Please specify those programming languages that you are proficient in

Please add any other information you feel will assist the NCSI staff in evaluating your application: