Application for
Studies in Air Quality for Science Educators
July 15 – 20, 2012
Sponsored by the STORM Project at the University of Northern Iowa
Applications received by February 17, 2012 will receive first consideration
------------------------------------------------------------------------------------------------------------------------ -------------------Please complete this form, sign, and return to:
Professor Alan Czarnetzki
Department of Earth Science
University of Northern Iowa
Cedar Falls, IA 50614-0335
Questions can be directed to:
Alan.Czarnetzki@uni.edu
PH: 319-273-2152
The school at which I currently teach is: __________________________________________________________
The school is located in (city and state): __________________________________________________________
1.
Name: ________________________________________________________________________________
(Last)
(First)
(Full Middle Name)
2.
Home mailing address: ___________________________________________________________________
___________________________________________________________________
(City)
(State)
(Zip code)
3.
Phone: ___________________________________
Cell: _____________________________________
4.
E-Mail address that you check often:________________________________________________________
(We will likely contact you by e-mail on or shortly after February 23, 2012 and then again as we get closer to July.)
5.
The university from which you received your degree(s); please also list your major(s):
Undergraduate _______________________________________________________________________
Graduate ___________________________________________________________________________
6.
If you were previously admitted to the University of Northern Iowa, what was your student identification
number? If you unsure of your admission status, please call Ms. Laurie Russell in the UNI Graduate
Admissions Office (319-273-2623). Ms. Russell can look up your student identification number.
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7.
a) List the classes and grade levels that you presently teach and years of experience with each:
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b) List the classes and grade levels you have taught in the past (if different from part a):
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8.
A primary goal of this course is the development of outstanding classroom activities that pertain to air
quality. Please discuss your qualifications for this course and for developing classroom activities. (You
may attach typed sheets.) Selection for the course gives strong consideration to this discussion.
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9.
10.
11.
Have you completed a college-level introductory weather
course or equivalent (e.g., the American Meteorological
Society’s DataStreme Atmosphere course)? (circle one) ……………………… Yes
No
I request on-campus housing during the course.
PARTICIPANTS ARE STRONGLY ENCOURAGED TO
RESIDE ON CAMPUS DURING THE COURSE. (circle one)…………… Yes
No
My signature below acknowledges my agreement to all of the following (please make a copy for yourself):
i.)
Accepted applicants will be notified on or shortly after February 23, 2012.
ii.)
I understand that if I am invited to participate in the course, I will be required to send a nonrefundable $25 application fee by March 2, 2012. If I do not respond to the invitation to
participate or fail to send the application fee by this date, I understand that my application may be
removed from further consideration. (Do not send the fee with this application.)
iii.)
I understand that if I am accepted into the course and am not currently admitted to the University
of Northern Iowa (UNI), I must be admitted to UNI prior to the course. The admission process
may require that I 1) pay a non-refundable $50 admission fee [do not send this now], which is
separate from the $25 STORM application fee, and 2) pay to have official undergraduate (and
graduate) transcripts sent to UNI for the graduate admission process. (If you previously received a
degree from the University of Northern Iowa or already have a UNI student number, the $50
admission fee will be waived and transcripts may not be needed.)
iv.)
I understand that the participant stipend and travel expense reimbursement are contingent upon my
successful completion of the course and that these payments will be processed soon after the
course ends but are not guaranteed to reach me by a certain date.
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(Signature)
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(Date)