East Tennessee State University

APPLICATION

to Participate in the

2017 Radio Astronomy Workshop

for Undergraduate Students

to be held at the

Pisgah Astronomical Research Institute (PARI)

Submit applications to: Dr. Beverly Smith at Department of Physics and Astronomy, ETSU, Box 70652,

Johnson City, TN 37614, or in person to Brown Hall 273, or via fax to (423) 439-6905

Application Deadline: Friday December 2, 2016

This workshop will be held March 3 - 5, 2017 (the first weekend of Spring Break) at the Pisgah Astronomical Research Institute in the Pisgah National Forest, near Brevard, North Carolina (traveling to Pisgah on Friday March 4). All costs for the workshop will be covered, including travel, room, and board. In addition, students will receive a $200 stipend for participation. During the workshop, students will review the basics of radio astronomy, and will learn how to operate the 4.6 meter radio telescope at PARI.

Students must be officially declared as either Physics majors, Physics minors, or Astronomy minors to participate in this workshop. We encourage students majoring in another science or in mathematics to consider participating in this program, particularly those interested in becoming a high school teacher.

After the workshop, students will be required to give presentations on radio astronomy in an ETSU Introductory Astronomy Laboratory and at a local high school. During these presentations, students will demonstrate the operation of the PARI radio telescope remotely over the Internet, and will direct the students in those classes in exercises based on the radio telescope. Before the high school presentations, workshop participants will meet with the high school teacher to review their presentations and to discuss careers in high school teaching.

Space in this workshop is limited. Participants will be selected based on seniority at ETSU and cumulative GPA.

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Name (Mr./Ms.) ______

Last First Middle/Maiden

Student ID ______Telephone # ______E-mail ______

Address ______

Street City State Zip Code

County ______

Classification: ETSU Freshman____ Sophomore_____ Junior_____New Transfer Student ______

Cumulative College GPA ______Number of hours earned ______

In the space below or on an attached sheet, briefly describe your long-term career goals, and/or your interests in Physics and/or Astronomy.

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Optional Information (Statistical Purposes Only) Ethnic Origin: Asian ____ American Indian ______Black ______White _____

Permission to Release Information

Because of public law (The Family Education Rights and Privacy Act of 1974, commonly known as the Buckley Amendment) it is now illegal to divulge certain information contained in a student’s record without the student’s expressed authorization and knowledge. It is, therefore, necessary to have the following authorization in order to comply with the law and the request described below.:

I hereby request and authorize the release of information contained in my student records at East Tennessee State University to the workshop participation selection committee for the purpose of evaluation of candidates for the workshop.

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Student’s Signature Date

For more information, contact Dr. Beverly Smith at , or 423-439-8418,

or in Brown Hall 273.