2016 IAGD-GSA Accessible Field Course Application
This application is for Trip A of the 2016 IAGD-GSA Accessible Geoscience Field Trip in Denver, Colorado, open to post-secondary students with disabilities and Geoscience Faculty, with or without disabilities.  

Complete the following form and click on SUBMIT to complete your application. When you are finished, be sure to hit the SUBMIT button before leaving this page or your information will be lost.

If you are accepted to participate, your information will be sent to the Geological Society of America and you will be directed to register through the GSA Field Trip site.  
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First Name *
Last Name *
Participation Status *
What is the name of your Institution or School? *
Department
City *
State/Province *
Zip Code *
Country *
Phone Number *
Email Address *
Demographics
Gender *
Status of Diverse Ability *
(choose all that apply)
Required
Citizenship *
Are you a veteran of the military? *
Required
Current academic appointment
(Faculty Only)
Clear selection
Current Educational Status
(Students Only)
What is your current major (state "undeclared" if none)? *
(Students Only)
Partial travel support will be available.  Are you interested in receiving funds in order to participate?
(Students Only)
If you receive travel funding, are you willing to promote the accessible trip at the IAGD Booth in the Exhibit Hall during the GSA meeting?
(Students Only)
Clear selection
Extended Response Questions
We encourage you to compose your answers to these questions in a word processor and then cut and paste the resulting text into this form. This gives you access to conveniences like spell checking as well as the opportunity to save and reflect on your work before submitting.
Describe your interest and experience in earth science.  If you have ever participated in an outdoor earth science field trip, tell us about what you liked or disliked, and what you learned.  
(Student Response Only)
Describe your experience in providing accessible instruction for students with disabilities.  If you have previously conducted an accessible field-based course, tell us about the content focus, objectives, how it went, and what you learned as a result.
(Faculty Response Only)
Describe how your participation in this field course will have an impact on your future efforts. *
(Both Student and Faculty Response)
If there is other information relevant to your application, please let us know here:
How did you hear about this opportunity? *
(choose all that apply)
Required
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