Application for

Studies in Weather Analysis and Forecasting for 
Science Educators
July 18 - 23, 2004

Sponsored by the STORM Project at the University of Northern Iowa

Applications received by March 5, 2004 will receive first consideration
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A complete application will consist of (1) this form; and (2) an application fee of $25 (send checks only and make payable to the University of Northern Iowa).  

Please complete this form and return it along with the application fee to:

Professor Alan Czarnetzki
Department of Earth Science
University of Northern Iowa
Cedar Falls, IA  50614-0335

Questions can be directed to:

Alan.Czarnetzki@uni.edu
PH:  319-273-2152 or 319-273-3788


The school at which I currently teach is: 
					 __________________________________________


1.	Name: _____________________________________________________________________
                          (Last)                    (First)               (Initial)


2.	Mailing address: __________________________________________________________


		     	 __________________________________________________________
                               (City)                      (State)       (Zip code)


3.	Phone:  ____________________________



4.	E-Mail:  __________________________________________________________________
              (We may contact you be e-mail on or shortly after March 5, 2004.)



5.	The university from which you received your degree(s):
			
			Undergraduate ____________________________________________

			     Graduate ____________________________________________


6.	What was your major?  ____________________________________________________






7.	If you were previously admitted to the University of Northern Iowa, what was

	your student identification number?	__________________________________
	
8.
a) List the classes and grade levels that you presently teach:  

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________


b) List the classes and grade levels you have taught in the past 
   (if different from part a):

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________


9. Please discuss your interests in atmospheric science as they pertain to this course.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

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10.    Have you completed a college-level introductory weather course or equivalent 
	(e.g. the American Meteorological Society's DataStreme course)?
								
						(Circle one)	Yes		No
	

11.  I request on-campus housing during the course.	    	Yes       	No                   


12.  I would like to receive graduate credit for this course.   Yes         	No                   



13.	My signature below acknowledges my agreement to all of the following:

i.)	I understand that my application fee will be refunded only if:
a) I am not accepted for participation in the course, or	
b) I am accepted but rescind my application by March 12, 2004.

ii.)	I understand that if I am accepted into the course and am not currently admitted to the University of Northern Iowa (UNI), I must be admitted to UNI prior to the course.  The admission process may require that I pay a non-refundable $30 fee, which is separate from the $25 STORM application fee.






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              (Signature)                                      (Date)