Application for support to attend
PDE-03 Conference
Northwestern University

June 12-15, 2003

Please fill out the following form if you are interested in applying for funds to help support your participation in the conference. We are especially interested in helping to support the participation of graduate students, post-doctoral researchers, and active senior researchers who have no grant support. We particularly encourage people who belong to currently underrepresented groups (minorities and women) to apply. Please return this form as soon as possible. Though forms can be sent in any time up to the end of the conference, we will start giving support after April 6, 2003, until the funds run out.

Name: ______________________________ Affiliation:__________________________

Mailing Address: __________________________________________________

___________________________________________________________________

Telephone: ______________________________Fax:__________________________

Email: ______________________________ Sex:_____________________

What are your research interests? ___________________________________

___________________________________________________________________

Do you have access to funds (e.g. department or grant) from which participation
in the conference could be funded? _____ yes _____ no

Are you a graduate student? If so, what year of graduate study are you in? _________

Do you belong to groups of minorities? If yes, please specify___________________

Since most of the financial aid will be given for room expenses, please
let us know which nights you will need a room:______________________________

Please attach a brief Curriculum Vitae and/or publication list.

Return this form as soon as possible to: 

   Ms. Melanie Rubin, Department of Mathematics, Lunt Hall
        Northwestern University, 2033 Sheridan Road
        Evanston, IL 60208-2730, USA
        FAX: (847) 491-8906, Phone: (847) 491-8035
        Email: melanie@math.nwu.edu