APS Bridge Program
 
Member Institution Application
 
Institutional Information:
* Institution:
Website:
* Department:
Address1:
Address2:
Address3:
City:  State:  Zip: 
  *  Please select your institution type:
  College/University      National Lab       Private Sector    
Information provided in the Institutional Information section will be made available on the APS Bridge Program site.

Please list information for key contacts:
  Most typically, this is the Director of Graduate Studies at a University, Director of Undergraduate programs at an Bachelors inst, or a Postdoctoral Program Coordinator at a National Lab or Company.
               Main 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: 

* Diversity Initiatives:
  Does your organization have any current or planned diversity initiatives or programs that would be helpful to underrepresented minorities in your department?
  
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Comments and questions (optional):
  Please provide any additional comments or information about your institution's minority graduation and enrollment rates.
  
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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:    

Please upload a PDF of a letter from your institution's physics department, department lead or head that includes a statement of support of APS-BP goals and mission, endorsement of the Joint Statement on Diversity in Physics, and a commitment to provide annual departmental diversity data.
Statement of Diversity      BP mission statemnet