SC2000 MSI Grant Submission Form

Please complete all parts of this form.

First Name (Middle Initial)	Last Name	Title Dr. Prof. Ms. Mr.
	Academic Institution	Type of Organization Select One Tribal HSI HBCU
Street	City State/Province	Zip/Postal Code Country
Phone	Fax	Email

What is the highest level of education you have completed? Select One Associate's degree Bachelor's degree Some graduate courses Master's degree Master's degree+ Doctoral degree	What is the area of your present professional work? Select One Computer Science &/or Engineering Biological Sciences Mathematics and/or Physical Sciences Liberal Arts &/or Fine and Applied Arts
Other (please specify)	Other (please specify)
To what extent do you conduct professional research? Select One Frequently Sometimes Does not apply	To what extent do you use high performance computing resources (HPC) for your work? Select One Frequently Sometimes Does not apply Would like to use HPC resources but do not at present
If you use HPC resources, what type(s) of HPC equipment do you use?
Briefly describe your areas of professional interest:
Are you a US citizen or permanent resident? US citizen Permanent Resident	Have you ever attended the SC conference before? Yes No
Please state briefly why you would like to attend SC2000:
Please state briefly how our support of your SC2000 participation will further our goals of reaching out to underserved groups:

SUBMIT!

Please review all of your information for completeness and accuracy. When ready to send, click on the submit button below.