Application form for New England Workshop on Science & Social Change
October 6-9, 2017, http://sicw.wikispaces.com/newssc17a
Suggestion: Prepare the requested information in a file before copying & pasting it in here (so you don't have to start over if the form crashes & so you can paste into the little boxes).
Workshop
Your answer
Name (First then Last name)
Your answer
Preferred email
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Contact telephone number, skype name, or google+ gmail address
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Affiliation
Your answer
Project of inquiry and engagement around workshop theme (100-500 words) *
(Your provisional idea of the project that you plan to develop and write about during the workshop, and to be implemented when you return home.)
Your answer
Other Relevant Info, but not for distribution
Your answer
Selected relevant publications, courses, websites, research work, institutional development and other experience related to workshop theme and process
Your answer
Request for subsidy of travel and accommodation, if needed
(Indicate if you plan to submit a working paper to guarantee a travel subsidy)
Your answer
ignore this slot
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Preference for single occupancy room or OK to share
(Indicate if you are arranging your own accommodation.)
Your answer
Suggested people (+emails) to invite if spaces are available
Your answer
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