APPLICATION FOR AWM Travel or Mentoring Grant PRE-SURVEY To complete your application, please download this five-part questionnaire and answer each question. Feel free to insert more space as needed for your answers, if the space provided isn't adequate. When you've finished this form, please e-mail it (preferably attached as a Word or Plain Text document) to sheppje@auburn.edu, e-mail of Judith Sheppard, the AWM Grant Program's independent evaluator, BY THE DEADLINE of the grant for which you're applying. PART I: Please fill in the blanks and indicate the correct answer as required. 1. My name is: (Remember, the survey part of the application process is confidential.) 2. I am applying for a travel/mentoring grant with a deadline of February 1/ May 1/ October 1 of ____________ (year). 3. My e-mail address is: PART II: PERSONAL INFORMATION 1. What is your age? ________ 2. When did you receive your degree (Ph.D. or equivalent)? ________ 3. Did you complete a post-doctoral program? ____ Yes ____ No 4. Tell us about where you are currently employed. If you are unemployed, please indicate that and go on to No. 6. ¥ What is your present position (title/rank)? ¥ Is your institution or an academic or nonacademic institution? Please name it. ¥ If it is an academic institution, please tell us the highest degree it grants (Ph.D. or equivalent, M.A., B.A. or B.S.). ¥ When did you begin your present position? ______ 5. Please tell us briefly about your teaching responsibilities. ¥ I teach _____courses spread over _____semesters/quarters (circle one) per year. ¥ Additional responsibilities (please check all that apply) _____ undergraduate advising _____ graduate advising _____ supervising undergraduate research _____ supervising graduate research _____ tutorials _____ committee assignments _____ other 6. Extraprofessional considerations. Are there external factors, such as familial responsibilities, or internal factors (i.e. support or lack of it for you or your discipline at the departmental, school or college level) which have so far affected your professional progress, either negatively or beneficially? 7. Why did you decide to apply for this grant? 8. In what way(s) do (did) you anticipate that this grant will (would) help you advance your career (if different from the answer to #7)? PART III: ABOUT YOUR DEPARTMENT 1. Estimate the number of tenure-track faculty (i.e., full professors, associate professors, assistant professors) in your department. ______ How many non-tenure-track faculty (i.e., instructors, adjuncts, visitors, post-docs)? ______ 2. Estimate the number of tenure-track positions filled by women. ______ 3. Estimate the number of women in your department who are tenured. _____ 4. Estimate how many of those tenured women faculty members who are full professors. ___________ 5. What travel funds are available to you through your institution? Please be as specific as possible. Are all faculty guaranteed funds annually, or are they competitive? Can you draw from more than one source? Did you receive start-up grant money upon your employment at your institution? Estimate the dollar amounts per year. PART IV. SCHOLARLY ACTIVITIES 1. How many conferences have you attended in the last twelve months? At how many of those meetings did you give ¥ an invited presentation _____ ¥ a submitted presentation _____ ¥ a poster presentation _______ 2. How many mathematics meetings outside the United States have you attended in the last twelve months? ______ At how many of those international meetings did you give ¥ an invited presentation _____ ¥ a submitted presentation _____ ¥ a poster presentation ______ 3. Please list the proposals, pending or granted, that you have submitted in the last twelve months. With each one, note the dollar amount asked for and received, the time period of the grant, and the granting institution. 4. Please list the papers, book chapters and books you have written over the past five years. Please note if the work has been published, accepted for publication or submitted but not yet accepted, and to which publications or presses. 5. Please list any other public presentations given (e.g., visiting lectures, seminars, workshop presentations, etc.) you have given during the past year. 6. Please list any conference sessions or panels you have organized over the past year. PART V. COMMENTARY AWM is interested in your views about how the application process for these grants can be improved, and what concerns and issues you have about the status of women in mathematics and the field of mathematics in higher education and research. Please feel free to offer any comments you think will help us as AWM continues to play a role in these important arenas. Be as brief or as complete as you like. You've now completed the pre-survey required by those applying for an AWM Grant Program travel or mentoring award. Thank you, and good luck!