Materials Aspects of Manufacturing Technology

2000 Institute Program Application

Name_____________________________ School where employed ___________________

Address___________________________ School location (city, state)_________________

City, state, ZIP _____________________ School phone for daytime contact

Telephone (____)__________________ (______)______________________

e-mail (if any) _____________________ FAX (if any) __________________

If you are part of a team of attendees, please name the other team members: __________

________________________________________________________________

Subjects you teach (or have taught), with grade level: ____________________________

Do you plan to introduce materials concepts into existing courses? Y N

If so, which courses? _______________________________________________

Do you want to plan a new materials technology or materials engineering course? Y N

If so, when would you offer it first? ___________________________________

What specific experience do you have with materials technology: ___________________

_________________________________________________________________

Have you attended materials technology-related institutes before? Y N

If yes, please indicate location and year__________________________________

List any industrial experience: ______________________________________________

Other relevant experience or special circumstances or needs: ______________________

______________________________________________________________________

Your academic background with degree(s) and schools(s): ________________________

Will you want academic credit for this program? Y N

Clock hours? Y N

On a separate sheet, please write a short paragraph indicate why you want to attend this institute, what you can contribute and what you hope to get out of it.

Return by mail or FAX to:

Materials Technology Institute, Department of Materials Science and Engineering,

University of Washington, Box 352120, Seattle, WA 98195-2120

FAX (206) 543-3100

Deadline for receipt for priority consideration is March 31, 2000