Summer Workshops 2004 Application Form

To apply to for the workshops complete and submit the form below.
Application deadline is April 18, 2004.

The Workshops Please rank the following workshops in your order of preference to attend (1 being most preferred; 3 least preferred; 0 not interested):
Ohio State Univeristy:
UC Santa Barbara:
San Diego State University:
Not sure? See Which workshop should I apply for?

Personal Information
First Name:
Last Name:
Affiliation:
Address:
City:
State:
Postal Code:
Country:

Citizenship:	US citizen US Permanent Resident Other (describe below):

Email:
Phone:
Gender:	Female Male
Ethnicity:*	African Amercian Hispanic American Native American Other (describe below):

* SPACE encourages applications to achieve a broad representation of all citizen groups, including underrepresented minorities and applicants from designated minority-serving institutions. This field is optional.

Academic Background Note: SPACE workshops are limited to individuals with instructional appointments at colleges and universities.
Discipline / Teaching interest:
Highest Academic Degree Attained:	MA MSc PhD Other (describe below):

Academic Rank:	Lecturer Assistant Professor Associate Professor Professor Other (describe below):

Academic Appointment:	Limited-term appointment Untenured academic appointment Tenured academic appointment Other (describe below):

Teaching Experience

How many years have you been teaching at the college/university level?

Please list the titles and academic levels of courses you have taught in the past 2 years.

Do you currently teach spatial approaches in your undergraduate courses? If so, please describe.

Have you participated in instructional development and professional development programs offered through your institution, discipline organizations, or other agencies? Please describe.

Do you have any experience with course evaluation and student assessment? If so, please explain.

Have you participated in previous CSISS, SPACE, or ICPSR spatial analytic workshops? Please describe.

Concept Familiarity Rate your proficiency in the following areas where: 1 = No familiarity 2 = Familiar with concepts 3 = Experience with applications 4 = Know enough to teach 5 = Expert
	1	2	3	4	5

Spatial thinking:
Cartography/map making:
Data management:
Internet search and information retrieval:
Graphic visualization of data:
Qualitative methods in social science:
Quantitative methods in social science:
Undergraduate curriculum development:
GIS:
Spatial statistics:
Other (describe below):

Software Experience

Please list any software that you currently use for research:

Please list any software that you have students use in your classes:

Do you and your students have access to spatial analytic software at your institution? Please describe:

SPACE Workshop Referral

How did you learn about the SPACE Workshop Program?

The SPACE/CSISS Website
SPACE Workshop flyer
Colleague
Newsletter (please specify below)
List Serve (please specify below)
Other (please specify below)

Statement

How do you hope/plan to use the workshop experience to enhance your undergraduate courses, programs, and student learning experiences?:

Other Comments:

-or- Mail / Fax to:
SPACE / Department of Geography
University of California
3510 Phelps Hall
Santa Barbara CA, 93106-4060
Fax: 805-893-8617

Printable Version

Summer Workshops 2004 Application Form

The Workshops

Personal Information

Academic Background

Teaching Experience

Concept Familiarity

Software Experience

SPACE Workshop Referral

Statement