APS Bridge Program
 
Institutional Information:
* Institution:
Website:
* Department:
Address1:
Address2:
Address3:
City:  State:  Zip: 
  *  What type of institution are you? (Select one, according to the highest degree in physics offered at your institution):
  Bachelor       Master       Doctoral     Affiliate *
  * Affiliate - An institution that plays a supporting role in improving diversity in physics education but does not award degrees
Information provided in the Institutional Information section will be made available on the APS Bridge Program site.

Contact Faculty:
  Please list any faculty at your institution interested in increasing educational opportunities for underrepresented minority physics students. These contacts will receive news and project updates via the Bridge Program email list.
               Main Faculty Contact
* Name:
* Email:
Phone:
Address1: 
Address2: 
Address3: 
City:  State:  Zip: 
               Additional Contact 1
Name:
Email:
Phone:
Address1: 
Address2: 
Address3: 
City:  State:  Zip: 
               Additional Contact 2
Name:
Email:
Phone:
Address1: 
Address2: 
Address3: 
City:  State:  Zip: 
               Additional Contact 3
Name:
Email:
Phone:
Address1: 
Address2: 
Address3: 
City:  State:  Zip: 
Information provided in the Contact faculty section will be made available on the APS Bridge Program site.
* Diversity Initiatives:
  Does your university or department have any current or planned diversity initiatives or programs that would be helpful to underrepresented minorities in your department?
  
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Minority Physics Degrees Awarded:
  How many underrepresented minority physics students have graduated from your institution during the past three years? For this program, APS defines the term underrepresented minority as African Americans, Hispanic Americans, or Native Americans who are U.S. citizens or permanent residents. We ask that you update these numbers annually to maintain your membership.
  Bachelor's degrees
(3 year total)
Master's degrees
(3 year total)
Doctorate degrees
(3 year total)
African American         
Hispanic American        
Native American        
Total          

* Currently Enrolled:
  Please comment on enrollment of underrepresented minority physics students at your institution.
  
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Comments (optional):
  Please provide any additional comments or information about your institution's minority graduation and enrollment rates.
  
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Faculty Members:
  How many underrepresented minority faculty members are in the department? Postdoctoral researchers?
Number of minority tenure-track or tenured faculty in the department:  
Total number of tenure-track or tenured faculty in the department:  
Number of minority postdocs in the department:  
Total number of postdocs in the department:  

How did you hear about the APS Bridge Program? (check all that apply)
     At a conference:    
     From a colleague
     From a member of the project staff
     From a print publication:    
     From a website:    
     Other:    

Information provided in the Diversity Initiatives section will be made available on the APS Bridge Program site.