REGISTRATION AND TRAVEL REPLY FORM
TO BE COMPLETED BY INSTITUTIONS ELIGIBLE TO RECEIVE QEM SUPPORT
QUALITY EDUCATION FOR MINORITIES (QEM) NETWORK
Historically Black Colleges and Universities Undergraduate Program (HBCU-UP) Workshop
The Embassy Suites Hotel New Orleans-Convention Center
315 Julia Street ¥ New Orleans, LA 70130 ¥ 504/525-1993
Thursday – Friday, October 5-6, 2006
This workshop is for HBCUs that are eligible to submit a planning or multi-year proposal in the National Science FoundationÕs HBCU-UP FY 2007 Program competition. QEM will make travel and lodging arrangements and cover the associated expenses for participation in the workshop, in accordance with the attached QEM Travel Policy, of up to two representatives from each eligible HBCU institution provided one of the two individuals is the institutionÕs chief academic officer who is expected to serve as the proposed projectÕs principal investigator. The second representative should be a science, technology, engineering, or mathematics (STEM) faculty member who would serve as the HBCU-UP ProjectÕs Co-Principal Investigator or Project Director. Workshop meals will be provided for all registered participants. Please provide the contact information below for the principal investigator and co-principal investigator/project director.
(1) Proposed HBCU-UP Principal Investigator (must be institutionÕs chief academic officer if
QEM support is to be provided):
NAME __________________________________________
TITLE _______________________________
INSTITUTION ____________________________________
TELEPHONE: ______________________ FAX: _______________________
E-MAIL: _________________________________________
(2) Proposed HBCU-UP Co-Principal Investigator/Project Director:
NAME __________________________________________
TITLE _______________________________ DEPARTMENT _________________________
INSTITUTION ____________________________________
TELEPHONE: ______________________ FAX: _______________________
E-MAIL :_________________________________________
If tickets or hotel accommodations arranged by QEM are not used, QEM will invoice the individual involved for these costs. Any additional costs resulting from changes in arrangements must be absorbed by the individual. If the chief academic officer does not attend the workshop, the institution will be invoiced for all costs incurred by QEM that is associated with travel and lodging arrangements for both individuals listed above.
Please e-mail the completed registration form to Shirley McBay at smmcbay1@qem.org by Friday, September 8, or send it by fax to 202/659-5408.
PLEASE NOTE: TICKETS WILL NOT BE PURCHASED UNTIL THE REQUIRED ONE-PAGE PROJECT SUMMARY HAS BEEN RECEIVED. ANY INCREASE IN AIRFARE RESULTING FROM THE RECEIPT OF LATE PROJECT SUMMARIES WILL HAVE TO BE ABSORBED BY THE INSTITUTION.