Online Application

First Name:

Last Name:

Title:

Institution:

Address:

City:

State: Zip:

Summer Address (if different):

Address:

City:

State: Zip:

Office Phone:

Home Phone:

Cell Phone:

Email:

Immediate Supervisor Name:

Immediate Supervisor Phone:

Immediate Supervisor Email:

A standard hotel room is reserved for each participant for five nights Sunday-Thursday.
Please indicate if you will not be requiring a room for any night:

Any special dietary requirements (breakfast and lunch provided; dinner allowance provided):

Any other special accommodations required:

The following are requirements to be considered for participation (space is limited and there is no guarantee of selection).
Please check the boxes to acknowledge that you meet these prerequisites:

	Teach full time in a tenure track position
	Teach at an NATEF Master certified community college
	Have a minimum of five years experience teaching automotive technology at the college level, with an emphasis in the electrical, performance and drive train systems
	Agree to improve your curricula as a result of attending the Advanced Automotive Hybrid Technology Summer Institute
	Agree to participate in follow-up activities to improve student learning, including an assessment of the workshop conducted by the Miami University Applied Research Institute

I will attend all 5 days.

The following question is to avoid spam bots from filling out the application form:
What is 1 + 3?