PEARC21 Student Program Application and Financial/Travel Support Registration Form

Personal/Contact Information
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code Country
E-mail *
example@example.edu
Will you be 18 years of age at the time of the ACM PEARC21 conference? *

Yes No
Are you currently enrolled as a full-time student? *

Yes No
University *
Please enter the university you are currently attending
Academic Classification *
Major/Area of Study *
Are you a full-time student? *

Yes No
Website (please enter an institutional website or a professional site/profile, i.e., MyNCBI, LinkedIn or similar)
Personal Photo

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OPTIONAL - Please upload a professional picture of yourself, no larger than 400x400 pixels) Cancel of
The information provided in this form will be used only by the ACM PEARC Conference Series. By providing this information, you agree to be contacted by ACM PEARC Conference Series organizers. *

Yes, I agree. No, I do not agree.

ACM PEARC21 Conference Submission Details
Reminder: Full-time students and any who have submitted to the general conference technical program will be given priority consideration.
Submission type *

Paper Short Paper Visualizations Panel Poster Tutorial Birds-of-a-Feather Workshop No Submission
Linklings submission number *
If No submission please write "Not Applicable";
Title(s) *
Please enter the title of your accepted submission(s). If No submission please write "Not Applicable"

Short Answer Questions
Please explain why you would like to be considered for participation in the ACM PEARC21 student program, including career goals and what impact you hope the program will have. *

0/400
Please describe your experience with advanced research computing (computation, data, visualization, analytics, high performance computing resources, etc.). Include what resources you have used, what type of software you have worked with, what type of experiments or science applications you studied, etc. Also, indicate how long you have worked in this area. *

0/250
What are some of your interests and hobbies, both professional and otherwise? *

0/150
What OPTIONAL elements of the student program are you interested in attending? Participation in this events is LIMITED. We will use a random selection generator if we have more applicants than spots. Please see the student program website for further details. *

Mentor/Mentee program Elevator Pitch (PITCH IT) Workshop Resume Clinic None of the above
Resume/CV (Required if you will be participating in: Mentor/Mentee, Resume Clinic, or Elevator Pitch (PITCH IT).

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US scholars may apply for a $50.00US registration waiver
How is your PEARC participation supported? *

University Self Grant I do not have funding support
Will you require a registration waiver? *

Yes No
Please tell us why you should be considered for a registration waiver

0/250
If ACM PEARC21 and the National Science Foundation pay for your registration fees, you are required to attend all student program sessions, and as many general conference sessions as possible. Please type your name below to acknowledge that you understand and agree to this requirement. *

Travel Grant Information

If you are requesting funding, you must complete the attached PDF and then upload the completed version. Your application cannot be considered for funding without receipt of this form.
If you are requesting funding, you must complete the attached PDF and then upload the completed version. Your application cannot be considered for funding without receipt of this form.
Are you requesting financial support? *

Yes No
Departure Airport *
Please enter the airport from which you will start your trip to PEARC19. If you are not flying, place NA in the box.
Upload of Completed Student Travel Request Form. If you are NOT requesting financial/travel support please fill and upload the form and indicate so in the text box for explaining your request. *

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Travel Grant Information