GRAD STUDENT Wakonse Fellowship Application - Submit by March 24, 2012

Name: Phone:
Department: Expected year of graduation:
Role: (this form is for graduate students - others fill out a different form)
I have read the information at the Wakonse website that describes the conference and the facility: setting, sessions, accommodations, meals, phone access, no smoking, etc..
If accepted I am available Memorial Day weekend and I agree to attend from noon Thursday May 24 through noon Tuesday May 29 (includes travel time).
If accepted I agree to pay a non-refundable fee of $100; the Kaneb Center will pay the balance of the $700 registration. Transportation is not included (carpools will be organized).
I understand that there is no provision for children or significant others to attend.
During academic year 2011-12 my most involved teaching role at Notre Dame will be
  Teaching an entire course Assisting Grading Leading labs or small groups
No teaching role I will not be at ND
Here is what I hope to take away from the conference (200 words or less):
 
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Revised February 21, 2012
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353 DeBartolo Hall
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