"Women in STEM in LATAM" Registration Form

Symposium "Nuclear Nonproliferation and Security for Women in STEM in Latin America and the Caribbean" (June 19 - 23, 2023)

Please complete all sections. Compulsory fields are marked with an asterisk (*). Your information will be kept strictly confidential. If you have questions or need assistance, please email Giovana Rodrigues Manfrin: grodriguesmanfrin@middlebury.edu. Application Deadline: May 19, 2023
Today's Date*

MonthDayYear
Personal Details
Name*

First NameMiddle NameLast Name
Age*

Below 2525-3536-4546-55Above 55
E-mail (where course organizers can reach you)*
example@example.com
Which most closely describes your gender?*
All genders are welcome to apply, but priority will be given to women working in fields related to nuclear nonproliferation and security.
What are your pronouns?
This helps us understand the best way to address you.
Country of Residence*
Nationality*
Address*

Street Address

Street Address Line 2

CityCountry

Postal / Zip Code
Mobile Number*
Work Number
Academic and Professional Background
Level of Education*

Undergraduate (Bachelor)Graduate (Master)Post-Graduate (PhD)Other
Length of Professional Experience*

0-5 years6-10 years11-15 years16 and above
Current Employer Name and Address*
Current Job Title*
Type of Organization*

GovernmentUniversityResearch/Think TankNon-ProfitOther
Area of Study or Professional Expertise*
Short Essays

We would like to learn more about your interests and objectives in participating in this course. Please recall that the primary objective of the symposium is to provide female technical experts and scientists with a broader understanding of nonproliferation, the peaceful uses of nuclear energy and nuclear security policies, as well as the various institutions, tools, and mechanisms necessary to address current nonproliferation and nuclear security challenges.
Please discuss your primary job responsibilities. How does your background align with the symposium's primary objectives? (maximum 250 words)*

0/250
Please share how you would benefit from participating in this symposium. What specific knowledge and skills do you expect to receive from this course? (maximum 250 words)*

0/250
In your view, how would your organization or country benefit from your participation in this course? (maximum 250 words)*

0/250
Additional Questions
English Language Proficiency*

BeginnerElementaryIntermediateAdvanced
Barring emergencies, do you commit to attending all symposium sessions throughout the duration of the program in Sao Paulo, Brazil, from June 19 to 23, 2023?*

YesNo
If your previous answer is "no" and you will foresee any conflicts, please detail those reasons below:
Have you attended any in-person or virtual course in nuclear nonproliferation or security in the past?

YesNo
If your previous answer is "yes" please list the course's name and country where you participated:
Have you attended any courses organized by the James Martin Center for Nonproliferation Studies (CNS) before?

YesNo
How did you learn about our course?

InternetEmailAdvice from a colleagueInternal referralOther
Required Supporting Documents

This is a tuition-free event. Travel and accommodation support will be offered for selected participants. To be considered for selection and travel support, interested individuals should submit this online form in addition to the following documents: (1) Resume or CV, and (2) List of at least 3 references with contact information (title, organization, email, and phone number). Incomplete applications will not be reviewed.
Please upload: (1) Resume or CV; and (2) List of at least 3 references with respective contact information (title, organization, email, and phone number). Files accepted include Word or PDF.*

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Symposium "Nuclear Nonproliferation and Security for Women in STEM in Latin America and the Caribbean" (June 19 - 23, 2023)

Personal Details

Academic and Professional Background

Short Essays

Additional Questions

Required Supporting Documents