QUALITY EDUCATION FOR MINORITIES (QEM) NETWORK

HBCU-UP PROPOSAL FOLLOW-UP WORKSHOP

The Embassy Suites Hotel New Orleans-Convention Center

315 Julia Street • New Orleans, LA 70130 • 504/525-1993

Saturday, October 7, 2006

 

PARTICIPANTS’ REGISTRATION AND/OR TRAVEL REPLY FORM

This follow-up workshop is designed for institutions that participated in the September 2005 QEM/HBCU-UP Proposal Development Workshop at the Washington Marriott Hotel in Washington, DC, and that submitted a proposal to the FY 2006 NSF/HBCU-UP Program competition, whether or not the proposal was successful in receiving funding. Others (see description below) may attend at their own/institution’s expense.

 

For institutions (1) participating in QEM’s HBCU-UP workshop in Washington and (2) submitting an FY 2006 HBCU-UP proposal, QEM will cover workshop-related expenses for the proposed principal investigator identified in the proposal. Complete Part I of this form for this individual. QEM will make travel and lodging arrangements for Part I participants and will reimburse other workshop-related costs in accordance with the attached QEM Travel Policy. Other institutional representatives from institutions in this category are welcome to attend at their institution's expense. Such individuals should complete Part II of this form.

 

Representatives from institutions that either: (1) did not participate in the QEM/DC Workshop in September 2005 but submitted a proposal in the FY 2006 HBCU-UP competition; or (2) participated in the QEM/DC workshop but did not submit a proposal are welcome to attend the follow-up workshop at their own/their institution’s expense. To register, individuals in this category must complete Part II of this form.

 

Part I: To be completed by individuals whose expenses are to be supported by QEM

 

Please provide the information below no later than FRIDAY, SEPTEMBER 8, 2006 to assist QEM in completing travel and lodging arrangements. Send information to Althea Burns by e-mail at aburns@qem.org or fax at 202/659-5408.

 

NAME _________________________________________ Must be the proposed principal

investigator in the HBCU-UP proposal submitted in the FY 2006 HBCU-UP competition

 

TITLE __________________________________________ PI is normally the institution’s chief

academic officer (vice president/chancellor for academic affairs or provost)

 

INSTITUTION ___________________________________

TELEPHONE ____________________________________

 

FAX ____________________________________________

 

E-MAIL _________________________________________

 

The following information will be used to purchase an airline ticket, unless travel is by car, and to make lodging reservations for the Workshop. If this ticket is not used, QEM will invoice the individual indicated on this form for these costs. Any additional costs resulting from changes in these arrangements must be absorbed by the individual or his/her institution.

 

AIRLINE PREFERRED _________________           CLOSEST AIRPORT _________________

TRAVEL TIME TO AIRPORT (in hours) _______________

 

QUALITY EDUCATION FOR MINORITIES (QEM) NETWORK

HBCU-UP PROPOSAL FOLLOW-UP WORKSHOP

The Embassy Suites Hotel New Orleans-Convention Center

315 Julia Street • New Orleans, LA 70130 • 504/525-1993

Saturday, October 7, 2006

 

Part II: To be completed by individuals planning to attend the QEM/HBCU-UP Follow-up workshop at their own or their institution’s expense

 

 

Please check the category below to which you belong:

 

____ My institution participated in the September 2005 QEM/HBCU-UP workshop in DC and

submitted a proposal to the FY 2006 HBCU-UP competition but I am not the proposed

principal investigator.

 

____ My institution participated in the September 2005 QEM/HBCU-UP workshop in DC but

did not submit a proposal to the FY 2006 HBCU-UP competition.

 

____My institution did not participate in the September 2005 QEM/HBCU-UP workshop in

DC but did submit a proposal to the FY 2006 HBCU-UP competition.

 

 

NAME _________________________________________

 

TITLE _________________________________________

            (please include academic department, if you are a faculty member)

 

INSTITUTION ____________________________________

TELEPHONE ____________________________________

 

FAX ____________________________________________

 

E-MAIL _________________________________________

 

 

Please provide the information above no later than FRIDAY, SEPTEMBER 8, 2006, to assist QEM in planning for meals and break-out rooms. Send information to Althea Burns by e-mail at aburns@qem.org or by fax at 202/659-5408.