CCI Reconnect '09 APPLICATION FORM
CONTACT INFORMATION:
Name:
E-mail (mandatory):
Social Security # (mandatory):
Affiliation:
Department:
Address:
City:
Phone:
Home address:
City:
Phone:
State:
Fax:
State:
Fax:
Zip:
Zip:
E-mail address:
URL (if you have one):
AFFIRMATIVE ACTION INFORMATION
(optional)
Gender: Male__ Female__ Race or ethnic background: ___________________________
EDUCATION
Year received: Undergraduate degree:
Major:
Minor:
Graduate degree(s) or certification:
Graduate courses taken:
Year(s) received:

The CCI Reconnect Conference will be held from August 9 - 15, 2009.
(Sunday evening through Saturday afternoon)
1.
Why do you want to attend the Reconnect Program and how do you think you will benefit from it?
2.
(For faculty applicants only) a. What courses have you taught in the last two years? b. What courses will you (or do you) expect to teach in the next academic year?
3.
For our planning purposes, it is helpful to know whether you taught, taken or self-taught a course emphasizing text data analysis, machine learning, information theory and/or knowledge representation? Yes___ No___ (A sentence will suffice.)
4.
What experience have you had in writing expository materials in mathematics?
5.
a. What research experience are you most proud of? (A sentence will suffice.)

b. When did you last experience doing research and what was it about? (A sentence or two about the topic will suffice.) We recognize that many applicants may not have done any research since their graduate school days. c. What creative activity have you engaged in that you are most proud of?
6.
Will you have an opportunity to use ideas from this conference in one or more of the following follow-up activities? (check all that apply)
 In a course. (Which one?) _________________________________________________
 Through an undergraduate research project.
 Through a departmental or interdisciplinary seminar in your campus.
 In government or industrial research projects.
 Other. (Explain) _________________________________________________________
7.
Applicants who are selected to attend this program are expected to attend for the entire program. If selected, will you be able to commit to participating for the entire program?
Yes___ No___
8.
Applicants who are selected are expected to complete their written classroom materials after leaving the program, by January 2010. Do you make this commitment?
Yes___ No___
NOTE: If you would like to append a sample of something you have written (lecture notes, a class handout, anything of that sort), please include it.