Application for Studies in Weather Analysis and Forecasting for Science Educators July 10 - 15, 2005 Sponsored by the STORM Project at the University of Northern Iowa Applications received by March 4, 2005 will receive first consideration ------------------------------------------------------------------------------ A complete application will consist of (1) this form; and (2) an application fee of $25 (send checks only and make payable to '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 address that you check often:____________________________________ (We will likely contact you by e-mail on or shortly after March 7, 2005 and then again as we get closer to July.) 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. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 10. Have you completed a college-level introductory weather course or equivalent (e.g., the American Meteorological Society's DataStreme Atmosphere course)? (circle one) Yes No 11. I request on-campus housing during the course. (circle one) Yes No 12. I would like to receive graduate credit for this course. (circle one) 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 11, 2005. 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 admission fee, which is separate from the $25 STORM application fee. (If you received your undergraduate degree from the University of Northern Iowa the $30 admission fee will be waived.) ________________________________________ _____________________ (Signature) (Date)