Student Application Form
NSF CMMI Engineering Research and Innovation Conference,
July 9-12, 2012, Boston, MA
Please submit this application form along with:
 Required 1-2 Page Research Description (see below)
 A 1-page resumé/CV.
Email the application package to cmmi2012@neu.edu no later than 5:00 p.m. Eastern
Daylight Time on Monday, April 16, 2012 (extended deadline).
Contact Information
Name
Street Address
City ST ZIP Code, Country
Home Phone
Work Phone
E-Mail Address (please use
academic email addresses)
University
Department
Research Adviser (name
and email)
Poster title & Research theme
Briefly summarize your research and academic objectives in one paragraph below. In addition, please
submit a 1-2 page narrative (figures and references allowed) attached to this form describing your
research and what you plan on presenting in your poster if invited to attend the conference. Moreover,
comment on how attending this conference will enhance your research and academic objectives as well
as how your research is related to the theme of the conference and the NSF-funded research being
presented.
How do your current research activities fit in with your long-term goals?
Write 2-3 paragraphs about what you would like to achieve with your training in the future and how
you can apply your knowledge and skills in the outside world. Note that this is NOT merely an
essay on the extension of your research.
Additional information
Are you working on a NSFfunded research project? If
known/applicable, please
list any award numbers
from which you receive
support.
Are you being supported
through research
assistantships or other
initiatives? Please describe
(funding source, duration if
known).
Are you from an
underrepresented group?
Are you a US citizen or
permanent resident?
Are you a Master’s or PhD
student?
Yes / No
Yes / No
Yes / No
How many years have you
been in the graduate
program?
If accepted, will you utilize
Northeastern University’s
housing? (Please note:
Students are expected to
arrive on 07/08 for preconference activities.
Housing will be provided
for four nights as part of
the award. Students will
NOT receive a cash
value if housing is
declined)
Will your faculty advisor be
providing additional travel
support for you to attend?
(Note that if your
application is approved,
you will not need to pay for
accommodation and
conference registration).
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand
that if I am accepted as a conference participant, any false statements, omissions, or other
misrepresentations made by me on this application may result in my immediate dismissal.
Name (printed)
Signature
Date
Our Policy
It is the policy of Northeastern University to provide equal opportunities without regard to race, color,
religion, national origin, gender, sexual preference, age, or disability.
Thank you for completing this application form and for your interest in participating at the 2012 NSF
CMMI Engineering Research and Innovation Conference in Boston, Massachusetts. For questions,
please contact the Graduate Student Program committee at cmmi2012@neu.edu.
.