SIMSMC Application

APPLICATION DUE APRIL 15, 2005

PLEASE INCLUDE WITH YOUR APPLICATION:

A curriculum vitae

A letter of support from your institution

     You may submit these materials electronically
     to MaterialCulture@mit.edu, by FAX, or by mail to:

     Professor Heather Lechtman
     SIMSMC
     MIT Room 8-138
     Cambridge, MA 02139

     FAX: (617) 253-8090

Name

First Name:         Middle Initial
Last Name:

Name of your Institution:

Department/School at your Institution:

Institution Address

Street:
City:             State:     Zip Code:

Work Phone:    ( )         Fax:    ( )

Preferred Mailing Address (leave blank if same as the above)

Street:
City:             State:     Zip Code:

Email Address:

Current Position:
Field:

Short Questions

Courses taught within the last two years:

Does any of these courses include a laboratory component (if so, please describe)?

Please describe your current program of scholarship or research.

How would you expect to utilize the experience gained at the
SIMSMC in your future teaching?

Which departments at your institution might provide teaching
partners for developing new joint courses stimulated by the
SIMSMC experience?

If your education is in fields other than Science/Engineering
it will be helpful for us to know what college level science/engineering
courses you have taken:

Have you had any other experience that might be relevant
to the goals of the SIMSMC?

How did you find out about the SIMSMC?

You may when done, or if you want to start over.