Institution:
Group/Department:
Address 1:
Address 2:
City:
State:	. . . AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY   Zip Code:
Group Phone:	Fax:

Individuals that will participate in QuarkNet at our institution are:

Name	E-mail	Indicate your QuarkNet leaders

Many institutions have worked with high school teachers and students prior to this effort. Please describe the outreach efforts of the individuals in your group who will mentor the QuarkNet teachers.

QuarkNet teachers must find a way to introduce their research experiences to their classrooms. Please describe one way that this can happen at your site.

What role do the individuals named above hold in this classroom transfer process?

Section II - Summer Research Information

Hardware Development

Hardware Testing

Software Development

Software Testing

Other

A complete description will include: Project Title, Mentor, Narrative Description

Where will the the teachers spend the bulk of their research time?

Fermilab

Within an easy commute of their homes

CERN

Other

If you checked Fermilab above, should we start seeking housing for your teachers now?

Yes, definitely.

Wait, don't arrange anything yet.

With which collaboration(s) is the research above affiliated?

ATLAS

CDF

CMS

D0

Other

Section III - Signatures

Submitting this form will generate a new HTML page with your responses. Please mail a hard copy of this page to Fermilab at the address printed at the bottom of the new page. You may include any ancillary material that you feel is pertinent in that mailing.

The page will also contain checkboxes indicating your agreement to:

actively mentor two teachers during the eight-week, summer 2003 research experience.

host those teachers at academic year meetings for the planning and development of a three-week research experience for up to ten of their colleagues.

recruit a second group of teachers and host their research appointment.

provide timely information for the completion of annual reports upon request.

continue to support the work of these dozen or so teachers beyond the initial two years of the center's existence.

The new page will also contain an area for signatures. The names that you have entered above will appear in the new document with a signature space left available. Please have the available individuals sign the hard copy before mailing.

You may wish to include the signatures of other individuals in the department such as group head, department head or dean. You may enter the pertinent information below so that the new HTML document will create signature areas for these individuals as well.

Name	Title