Windows to the Universe Partnership Application Form

Position

Organization Name

Organization Department (if any)

Street Address

City

Zip (mail) code

Phone

Fax

Email

I am interested in becoming a:

What is your field of scientific or educational research?

What is your highest academic degree attained?

What did you get this degree in?

At which academic institution did you get your degree?

When did you get your degree?

Please provide a brief description (150 words or less) of what you would like to achieve through partnership with Windows to the Universe, being sure to make clear what scientific subject area you would like to address with our audience.

Please provide a brief description (150 words or less) of your experience reaching out to the public, students, and educators in the past.

If you have them, please provide a few links to examples of your previous efforts in education and outreach, or resources you have developed for the public, students, or educators.

Please provide up to three references (with standard format citations) to your published work.