APS Bridge Program
Member Institution Application
Institutional Information:
*
Institution:
Website:
*
Department:
Address1:
Address2:
Address3:
City:
State:
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New York
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Ohio
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Pennsylvania
Puerto Rico
Rhode Island
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Tennessee
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Utah
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Virginia
Washington
West Virginia
Wisconsin
Wyoming
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:
Pick a State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Additional Contact
1
Name:
Email:
Phone:
Address1:
Address2:
Address3:
City:
State:
Pick a State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Additional Contact
2
Name:
Email:
Phone:
Address1:
Address2:
Address3:
City:
State:
Pick a State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Additional Contact
3
Name:
Email:
Phone:
Address1:
Address2:
Address3:
City:
State:
Pick a State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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