Fields marked with an asterisk are required.

Email*:	(yourname@domain.postfix[com, net, edu, etc..])	If you have previously entered your information, enter the same Email address that you used previously and click on the "Get" button below to retrieve your current application information.
First Name*:
Middle Initial/Name:
Last Name*:
Suffix (i.e., Jr.):
Gender*:	Please either indicate your gender or select "Decline to Report": Select One: Male Female Decline to Report
Race/Ethnicity*:	Please check which ethnicities apply (you may select more than one) or check "Decline to Report": American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Decline to Report Race/Ethnicity
Country of Citizenship*:	Area: Select Area: North America Asia Europe South America Oceania Africa Antarctica   Country:   If not a US Citizen, are you a US permanent resident? Select One: Yes No
Institution of current employment or studies*:	If your institution is not available on the list please send an e-mail message to the Webmaster with the name, city, state (if US), and country of your institution. We will add your institution to the list so you can complete the form. Search: -or- Area: Select Area: North America Asia Europe South America Oceania Africa Antarctica Country: State (Applies to US only): City: Institution:
Department:
Primary Field of Interest*:	Which of the following best describes your primary field of interest? Select One: Pure Mathematics Mathematics Education Applied Mathematics Applied Mathematics (Biological Applications) Operations Research Statistics Biostatistics Mathematics with Computer Science Other
Highest Degree*:	Please select one of the following (select "Other" if you have not yet obtained a degree): Select One: PhD or equivalent Masters or equivalent Bachelors or equivalent High School Diploma Other None
Year of highest degree (four-digit format), Bachelors and above. Leave blank if you have not yet obtained a degree*:
Institution of highest degree*:
Please review or select the most appropriate title*:	Select One: Academic Participant - Faculty Position Academic Participant - Postdoc Academic Participant - Student (Graduate) Academic Participant - Student (Undergraduate) Government/Military Participant High School Student Industry Participant Non-profit Organization Participant
Current Mailing Address:
Address1:
Address2:
City:
State/ Province:
Zip/ Postal Code:
Country:
Office Telephone:
Home Telephone:
Fax:

Will you attend the Etta Z. Falconer banquet on Saturday night?   (Enter Yes or No)  

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Research Interests (students only)

Please tell us about your interest in the mathematical and statistical sciences and the IPC. What areas of mathematics particularly interest you? What are you future professional goals? Finally, why are you interested in attending the IPC? (Your response is limited to 2000 characters.)

Supporting Documents (students only)

Please provide the selection committee with the following two letters to support your application.

1. Letter of recommendation from a faculty member who can address your commitment to mathematics, your academic performance and your desire to pursue a mathematics-related career.
2. Letter of commitment from a staff member of an organization where you will provide mentoring or tutoring services as a volunteer. See webpage for more information about this requirement.

For those who instead choose to present a poster or oral presentation at the IPC, this is optional.

Please ask the letter writers to include your full legal name and the name of the program in the letter. They may send their letters to ipc@ipam.ucla.edu or to mail the letter to:

IPAM
Attn: IPC2010
460 Portola Plaza
Box 957121
Los Angeles, CA 90095-7121

Please include here the name of the two individuals who will submit letters on your behalf, and their organization or institution. If you wish to present a poster or give a research talk at the IPC instead, please tell us here. You will be contacted separately to confirm your participation and to request your title and abstract.

 

Academic Performance (students only)

Current GPA:
Expected Graduation Year

Funding (students only)

Do you expect to fly to Los Angeles for the IPC? Select One: Yes No

Please estimate the cost of your travel (airfare or mileage) here.

 

Optional: Please enter the name of someone that you would like to share a room with.

 

Comments and Questions?

Please enter your questions, comments or suggestions here.

 

 

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