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  PCMI 2008: Designing and Implementing Professional Development

Application Factsheet   Application Form   Application FAQ   Program HOME  


Application Form    deadline January 20, 2008

Please read the Application Fact Sheet before submitting this application form.

Personal Information

Your First Name   Your Last Name
 

 

Your Email Address (required)   Institution/School Name
 
 
Your Primary (Home) Mailing Address   Other (Institution/School) Mailing Address
 
City State/Province   City State/Province
 
Postal code/Zip code   Postal Code/Zip code
 
Country   Country
 
 
Your home telephone number   Your office telephone number
 

What is your current position?

What is your gender?
Male      Female

What is your citizenship?   U.S. Permanent Resident Country of Origin
 
    Non-U.S. Resident Country of Citizenship
   
    Visa/Immigration Status
   

What is Your Ethnicity?    

  (U.S. Citizens and Permanent Residents: this question is optional, but helpful in assessing efforts to attract a diverse group of participants)
     
Have you attended PCMI before?
Yes No

How did you hear about PCMI?   If advertisement, please specify publication
 


Will you be able to attend
the entire Designing and Implementing Professional Development Program ?		   If not, please specify dates you can attend
Yes  No  


Attending the entire session is encouraged for all participants, and required of those who receive funding from PCMI. 

Financial assistance is available (applicants receiving assistance are given full support and a stipend during the Summer Session).
Would you like to request assistance?
Yes     No


If you are a PDO or PD3 leader, skip Sections 1-4 and go to Application Submission at the bottom of this form.

Section 1: Education and Teaching Experience

(Please use as much space as necessary to complete this section)

Describe an example(s)of professional development activities you have
lead or participated in that were particularly meaningful. This should
be limited to no more than 5.

Please attach your Curriculum Vitae (if available)

File size limit: 500k.
File formats accepted are Portable Document format (.PDF), Text (.TXT), Rich Text Format (.RTF), or Microsoft Word format (.DOC).
If you do not have an electronic copy of your C.V., you can mail or fax it to the PCMI office (information at the bottom of this form).

 

Section 2: Professional Development and Outreach Group information

  Have you been to PCMI before?   If so, which year(s)?
 
  Are you an active member of a local PCMI group?   If so, which group?


Section 3: Applicant's Statement

A. New Applicant's Statement

Please write a concise statement describing:

  1. Your interest in participating in the IAS/Park City Mathematics Institute with respect to what you would like to learn and the changes you would like to make in your own school district,
  2. Your aspirations and leadership potential for furthering secondary school mathematics education reform efforts among the other teachers in your geographic area,
  3. Your commitment to continued learning of mathematics.


B. Your Interest in the Designing and Implementing Professional Development Program

Please write a concise statement describing your interest in participating in the Designing and Implementing Professional Development Program with respect to the work you do and your work towards improving mathematics teaching and learning.

Section 4: Letter of Support and Recommendation

Please submit a letter of support from someone familiar with your work in mathematics education. Please specify the names and titles of your references below:

Reference Name Reference Relationship

Please attach letter of support (if available)

File size limit: 500k.
File formats accepted are Portable Document format (.PDF), Text (.TXT), Rich Text Format (.RTF), or Microsoft Word format (.DOC).
If you do not have an electronic copy of the letter of support, you can have it mailed or faxed to the PCMI office (information at the bottom of this form).

Application Submission

Send letters of support or recommendation,
as well as any other supplemental application materials
Postal Address
IAS/Park City Mathematics Institute
24 South 600 East, Suite 4
Salt Lake City, UT 84102
Email Address
pcmi@ias.edu
Fax
+1 (801) 363-1675
For more information or to ask about financial assistance
Telephone
+ 1 (800) 726-4427 or
+ 1 (801) 363-1672

Application deadline

Supplemental Material Deadline

January 20, 2008. Late applications may be accepted at the discretion of the organizers.

All supplemental materials must be submitted by January 27, 2008.

When you have completed this entire form, click "Submit Application," below - click only once.

If you have attached files to your application, please be sure that each one is smaller than 500k in file size (if any file is larger, you will not be able to submit your application). Please click the "Submit" button only once; the upload process may take several minutes.

Be sure to send all supporting material before the deadline. You may expect a response in early April via email.

 

PCMI is sponsored by The Institute for Advanced Study, Princeton, New Jersey