Women in the Sciences & Engineering Institute

Name:

E-mail:

Job Title/Academic Rank:

Department:

College:

Work #:

Job Classification:

How did you find out about WISE?	College Department Flyers/Posters Friends/Colleaugues Mailings Other

If you selected other to the previous question, please specify:

Would you be interested in being listed on the WISE "Role Model" database?	Yes No

Would you be interested in being actively invovled in WISE programs?	Yes No

If you selected yes to the previous question, please check all that apply:	Workshop leader Conference assistance Role model presenter Undergraduate programs Graduate programs K-12 programs Mentoring Advisor for student group

Do you feel any of the following barriers affect your success as a faculty or staff member at Penn State?	Outside responsibilities (work/family) Lack of a support group Discrimination Isolation Sexual harassment No barriers

What types of other activities or programs would you like to see WISE sponsor?