Who are you?
Your First Name: 
Your Middle Name: 
Your Last Name: 


Your address?
Institution: 
Department:  
Address Line #1: 
Address Line #2: 
Address Line #3: 
Daytime Phone:  
    
Cellphone: 


Your E-Locations?

E-Mail: 
                  Web page: 


What degrees have you completed?

Bachelors: 
  Area:  
  Institution: 
  Year Completed: 

Masters:
  Area:   
  Institution: 
  Year Completed: 

Ph.D.:
  Area:    
  Institution: 
  Year Completed: 

 Other:   
 Area:   
 Institution: 
 Year Completed: 


Where are you in your current program of study?

Area:  

 Year 1, M.S.
 Year 2, M.S.
 Year 3, M.S.
 Year 4, M.S.
 5+ Years, M.S.
 Year 1, Ph.D.
 Year 2, Ph.D.
 Year 3, Ph.D.
 Year 4, Ph.D.
 5+ Years, Ph.D.
 Other: 


Who will write a letter of recommendation supporting your application?

Title: 
Professor
Associate Professor
Assistant Professor
Other

Name: 
Phone: 





Some optional information which we are required 
to track, since this is a federally funded program.  
You are not obligated to answer these questions:


Birthdate: 
 (format mm/dd/yy)
Gender:  
  M F


Ethnicity:
 




Are you a U.S. Citizen
Permanent Resident
non-U.S.Citizen ?


If not a U.S. citizen or permanent resident, please list country of citizenship: 



What is your background in genetics and disease control?



Little or none (e.g. attended a few talks)
One or more courses
Other: 


During the workshop tutorials are being planned in between talks as a means of preparing
students for the next talk as well as decomposing/distilling the research topic of the
previous talk. In order to better plan tutorials to meet student needs, please answer each
of the following:

1. Have you had coursework that includes modeling and simulation techniques?  
yes   
no


2. What calculus have you completed?
Differential calculus?  yes no
Integral calculus?      yes no
Multivariable calculus? yes no


3. Have you had any linear algebra courses?  
 none
 one course
 two or more courses


4. Have you had any statistics courses?  
 none
 one course
 two or more courses


5. Have you had any coursework in elementary differential equations in one and two variables?   
yes   
no


6. Have you had coursework in stochastic processes?   
yes
no


7. Have you had coursework in Genetics?   
 none
 one course
 two or more courses


List of relevant math and biology courses you have taken:
(please indicate if it is a grad level course or an undergrad level course)


     1: 
     2: 
     3: 
     4: 
     5: 
     6: 
     7: 
     8: 
     9: 
     10:
     11:
     12:


What is your proficiency with computer algebra and graphical software?

Matlab
None Beginner Intermediate Advanced

Mathematica
None Beginner Intermediate Advanced

gnuplot
None Beginner Intermediate Advanced 

Maple 
None Beginner Intermediate Advanced

Octave
 None Beginner Intermediate Advanced
Other:
 




Do you want to submit an abstract for a talk or poster at the workshop?
yes
no
not sure at this time
 If yes, what it the topic? 
Check if you are ready to submit an abstract. (If you are ready to submit an
abstract, please go to http://dimacs.rutgers.edu/archive/Workshops/DisControl/applic1.html and upload
your abstract after you have completed the application form.)


Please indicate your preferences for covering the workshop costs 
(travel, housing, meals, and registration). 

Please indicate whether you need full funding or whether you have 
other sources of funding. If you have other sources of funding that might cover part 
of the cost please indicate below how much they might cover. Estimates are acceptable

 I would like to be considered for funding through the program, but will still attend the workshop if I receive no funding.
 I will only be able to attend the workshop if I receive funding through the program to cover costs.
 I would like to be considered for funding through the program, but will attend the workshop if I only receive partial funding.
 I am only applying for waiver of registration fees.
 Estimate of costs to be covered by other sources