Name:

Postdoc Associate
Graduate Student
Other

Institution:

Address:

E-mail: Phone:

If you are a graduate student, which of the following describes your situation in the summer of 2009:

Completed 1 year of graduate study in physics
Completed 2 years
Completed 3 or more years
Will have graduated or be in the process of graduating

Describe in one or two sentences your background and interest in nuclear and particle astrophysics and cosmology:

We expect students to attend for the full two-week period of the school. Will you be able to do so? Yes No

If not, please specify the reasons and the period you would like to attend.

Accommodation options

We expect (pending approval of grant requests) to cover the local housing and meal costs of students, using University of Washington dormitory rooms (double occupancy).

If this is satisfactory, and you know with whom you would like to share a room, please enter the name:

Name:

Alternatively, students can elect a single dormitory room or hotel accommodations, provided they bare the extra cost. If so, please indicate below:

Single dormitory room (extra cost $22/day)
Hotel (extra cost variable, depending on hotel choice)

Support

Do you wish to apply for local support? Yes No

Presentation

Time will be set aside for presentations by school participants. Would you like to give a presentation? Yes No

Please provide a title and one or two sentence description below.

As the number of slots for such presentations is limited, it may not be possible to accommodate all requests.

References

Please provide the names and contact information for two references that we might consult, in case we need more information.