Survival Skills & Ethics Program

Teaching Survival Skills and Ethics

Application Form

Teaching Survival Skills and Ethics
14th Annual Trainer-of-Trainers Conference
June 8-13, 2008
Snowmass, Colorado

You may apply on your own or as part of a team from the same institution (strongly encouraged). Note that in the case of teams, each team member must complete and submit an application form.

Completing the online form below will allow you to submit your registration to the Survival Skills Workshop electronically. Alternatively, if you prefer a paper version of the form you can download the Adobe PDF Version which you can complete and then fax the form to 412-578-3790.

* Required fields

Salutation

* First Name

Middle

* Last Name

Degree

Institution

Position

Program/Department

Mailing Address Line 1

Mailing Address Line 2

City

State

Zip/Postal Code

Country

* Phone xxx - xxx - xxxx

Fax xxx xxx - xxxx

* Email xxx@xxxx.xxx

If you are applying as part of a team, please identify teammate:

How did you find out about this conference?

Provide us with information on your teaching experience:

Briefly describe the types of courses and levels of students you have taught.

How do you plan to use the training you will receive at the conference? Be as specific as possible.

To whom will you make training in survival skills and ethics available?
Estimate the number of individuals in the groups listed below
(please enter a number):

Graduate Students

Postdoctoral Fellows

Faculty

Research Assistants

Undergraduates

Staff

Other, please specify

What disciplines will these individuals represent?

Describe any areas of experience or expertise that you have that are relevant to this conference.

Feel free to include any additional information that you think strengthens your application.

Travel Fellowships
Travel fellowships are available on a limited basis to support the participation of individuals who are otherwise unable to obtain the funding necessary to attend the conference. Do you wish to apply for a travel fellowship?

Yes (complete this section);

No (skip to next section of application).

The fellowships range in amount, based on need. A full travel fellowship covers all but $395 of the major costs associated with attendance. Single rooms are availablle at a cost of $365, charged to the individual. We regret that our funding source does not permit us to provide fellowships to individuals outside the US.

If you are applying for a fellowship, indicate how much you/your institution will contribute toward the cost associated with your attending the conference. (Minimum is $395. Please do not include in this amount any funds that will be used toward a single supplement.)

* Terms of participation
If accepted as a participant in the 14th Annual Workshop on Teaching Survival Skills and Ethics, I agree to all of the following three conditions:

I will participate in the entire workshop: Sunday afternoon through Friday evening.
I will establish or improve an existing course in survival skills and ethics at my institution by Fall 2009.
I will participate in an evaluation of that course. This evaluation will include surveying the participants of that course and providing the conference organizers with additional information such as a description of the program and permission to conduct an on-site, follow-up evaluation.

I agree to these terms

I do not agree to these terms

Conference information

The Survival Skills and Ethics Program: University of Pittsburgh
Hieber Building, Suite 202, 3500 Fifth Avenue, Pittsburgh, PA 15213 U.S.A.
Phone: 412-578-3716 | Fax: 412-578-3790 | Email: survival@pitt.edu