AAAS Project 2061 / Using Atlas of Science Literacy

Application for a Workshop Scholarship

AAAS Project 2061 Workshops

Washington, DC
October 12–14, 2011

AAAS Project 2061 workshop scholarships are supported by gifts from members and others to the AAAS Flexible Action Fund program. Each grant covers the regular workshop fee (a $375-$450 value). Funding is available for only a limited number of scholarships. Please see the Criteria for Awarding Scholarships prior to completing this form.

Answers are required for all questions except question 10.

Watch this space for additional information on workshop scholarships


1.	First name
	Middle initial
	Last name

2.	Name of school, institution, or organization

3.	Position/title

4.	Current mailing address
	E-mail
	Fax
	Phone (home)
	Phone (office)

5.	Highest degree earned
	Date earned
	Institution

6.	Level(s) of your present primary activity or special interest. Please check one or more. Pre-K, Early childhood years Elementary school Middle/Junior high school Senior high school Post-secondary institution Informal science educators Other (identify):

7.	Why should you receive a scholarship? Please describe your current position and responsibilities, your professional and leadership activities, and any financial need.

8.	How will you share what you learn at this workshop with your colleagues and/or with the wider science/mathematics education community?

9.	A workshop scholarship will cover only the registration fee (up to $450) for each individual recipient. The cost of required books, travel, and lodging are not included. If you receive this scholarship grant, what other sources of funding would be available to you to cover these additional expenses? Other local, state, or federal grants Private foundation grants Institutional grants Personal funds Other (identify):
10.	(Optional) Please check the appropriate category in (a) and (b):
	(a) Sex:	Male Female
	(b) Racial or ethnic origin:	American Indian or Alaskan Native Asian Pacific Islander Black (non-Hispanic) Caucasian/White (non-Hispanic) Mexican American/Chicano Puerto Rican Cuban Hispanic Other Multi-ethnic