DATES TBA University of Notre Dame
Information about you
First Name:
Last Name:
Email:
Phone:
Home address street:
City: State: ZIP:
Information about your school
Job Title:
School District (if applicable):
Employer:
Employer Phone:
Employer Address street:
Information about your background
Degree
Major/minor
Institution
Please state briefly why you are interested in the PIXE-PAN program. You can also send your personal statement to PIXE-PAN, or e-mail it separately. Please list any relevant laboratory work experience. Please list all subjects you have taught in the last five years. Current Teaching Load (subject, # of classes, # of students) Professional references
Please list two professional references whom we may contact.
Name
Title
Affiliation
Phone number
Accommodations and students
Do you plan to stay on campus?
If no, please tell us how you will get to ND and where you will stay.
