SAUM Workshops

Participant Application Form
Assessment at the Department Level Workshop Series
MAA Supporting Assessment in Undergraduate Mathematics Project
Supported by NSF Grant DUE-0127694


Date __________________


Team Member 1

    First Name _________________________________      M.I. ________

    Last Name __________________________________

    Institution ____________________________________________________________

    Department ____________________________________________________________

    Address ____________________________________________________________

    City _________________________      State/Province ___________     ZIP ____________

    Country ______________________     Phone (with AC)_______________________

    Fax __________________________      E-mail _____________________________

Team Member 2

    First Name _________________________________      M.I. ________

    Last Name __________________________________

    Address ____________________________________________________________

    City _________________________      State/Province ___________     ZIP ____________

    Country ______________________     Phone (with AC)_______________________

    Fax __________________________      E-mail _____________________________

Team Member 3

    First Name _________________________________      M.I. ________

    Last Name __________________________________

    Address ____________________________________________________________

    City _________________________      State/Province ___________     ZIP ____________

    Country ______________________     Phone (with AC)_______________________

    Fax __________________________      E-mail _____________________________

What component of your department's academic program will be assessed?




At what stage is the work on this assessment?




At what type of institution do you teach (Two-year, Four-year, Graduate)?




What is your position at your institution?




Mail, E-Mail or Fax application to the following address:

Assessment Workshops
Gretchen Brown   E-mail: GBrown@maa.org
Mathematical Association of America    Fax: 202 483 5450
1529 Eighteenth Street, NW   Phone: 202 319 8496
Washington, DC 20036