SPHS Workshop 2003 Application Form
    May 24-25, 2003    Indiana University

Please print out this form, fill in the blanks, and mail or Fax it to the contacts at the bottom. Deadline for Applications, March 20, 2003.

CONTACT INFORMATION (Please type or print):

First Name ____________________________    M. I. ____

Last Name _______________________________________________________

Institution: ________________________________________________________

Department: ________________________________________________________

Address: ______________________________________________________________


City: _________________________________   State/Province: _______   ZIP: ________________

Country: ____________   Phone (w/Area Code): ____________________

FAX:________________________   Email: ____________________________________________

Workshop sessions are scheduled from Saturday, 5/24 at 8:00 am until Sunday, 5/25 at 4:30 pm. Monday, 5/26, there are optional hands-on laboratory sessions available from 8:30 am to noon. Please indicate if you plan to attend:

  • Saturday & Sunday Sessions: Yes   or   No
  • Saturday night dinner ($25.00): Yes   or   No     If yes, how many? _______
  • Monday Laboratories: Yes   or   No

REASONS FOR APPLYING: Please attach a separate page which briefly explains the reason(s) you wish to attend the Problem Solving in SPHS Workshop, and how you plan to use what you learn. Please include previous experience you have had (if any) with teaching physics, mathematics, acoustics or technology in speech and hearing deparments.

We encourage up to two instructors from the same univeristy to apply. If you are applying with a partner, please fill in this section; otherwise leave it blank. Your partner(s) should submit a separate registration form.

NAME(S) OF PARTNER: ________________________________________________________

The SPHS Workshop is sponsored by NSF. Small grants of $300 will be awarded to 23 participants (grants limited to two per university). Forms to receive the funds will be completed at the Workshop. Funds can be used to cover the cost of rooms reserved at the student union (@$96/night, some doubles available), the dinner Saturday night and help defray transportation costs. Upon receipt and review of this application, you will receive a formal acceptance to attend Workshop as a participant and informed whether you will received with a small grant. Space is limited to 30 people whose applicantions are accepted on a first come, first serve basis.

HOW TO SUBMIT YOUR REGISTRATION: Print and mail or Fax this registration form and attached written statement to:

Department of Speech and Heairng Sciences
Indiana University
200 S. Jordan
Bloomington, IN 47405
FAX: 812 - 855-5531

Motel Information: Participants must make their own reservations for the Imdiana Memorial Union by May 1. More information on this will follow

Travel Instructions: The nearest airport to Bloomington is Indianapolis. Note that because the Indianapolis 500 Race is being run this weekend, you should buy airline tickets early. Directions to the motel are available on the motel web site above. The Bloomington Shuttle Service goes from the airport to the motel: http://www.bloomingtonshuttle.com/airport.html More information about IU can be found at: http://www.iub.edu/news/