Reconnect '03 Satellite Program – Salem State College
APPLICATION FORM
CONTACT INFORMATION:
Name:
E-mail (mandatory):
Social Security # (mandatory):
College/University:
Department:
Address:
City:
Phone:
State:
Fax:
Zip:
Home address:
City:
Phone:
State:
Fax:
Zip:
E-mail address:
URL (if you have one):
AFFIRMATIVE ACTION INFORMATION
(optional)
Gender: Male__ Female__
Race or ethnic background: ___________________________
EDUCATION
Undergraduate degree:
Major:
Minor:
Year received:
Graduate degree(s) or certification:
Graduate courses taken:
Year(s) received:
The DIMACS Reconnect Conference at Salem State will be held from June 15 to June 21, 2003.
(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. 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. a. Have you taught, taken or self-taught a Discrete Math course? Yes___ No___
b. Have you taught, taken or self-taught an Algorithm Analysis course? Yes___ No___
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 will 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.

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 2004. 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.