GEMS Associate's II Professional Development Application
Use this form to print out and FAX your application or apply online.

Please note: Only GEMS Associates are eligible to apply for Associate's II.

Name _______________________________________________________________
(as you would like it to appear on your name tag)

Partner's Name (if applicable)_______________________________________________

Institution/Work Address_______________________________________________________________

City ________________________ State ______ Zip __________

Work Phone ____________________

Position ___________________________________ Grade Level Involvement _________

Home address


City ________________________ State ______ Zip __________

Home Phone ____________________

Email ________________________

Which GEMS Associates Workshop did you attend? __________________________________

Are you affiliated with a GEMS Site or Center? _______ If so, where?___________________

Visa or MasterCard accepted (please include: Cardholder's Name, Card Number, Expiration Date).
Make check/purchase order to: Regents of the University of California

Associates II Professional Development:

Poster Session 4-6 PM May 9th; remaining sessions 8:30-3:30 May 10—12, 2005.

Associates II Fees:
$430 per person; $395 per person for two or more attendees.
Fee includes reception, workshop fee, parking, and lunch each day. Travel and lodging not included.

Associates II Applicants
Your application will be evaluated based on your responses to these questions. Please attach a separate sheet of paper.

  • How are you currently using GEMS in your role as an Associate? (Please give detailed information)
  • What do you hope to gain from the Associates II Seminar?
  • What do you feel you have to contribute as a participant?
Mail application and payment to:
University of California, Berkeley
GEMS Professional Development
Lawrence Hall of Science # 5200
Berkeley, CA 94720-5200

Questions? Call GEMS at (510) 643-0672

GEMS Professional Development

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Lawrence Hall of Science    © 2005 UC Regents. All rights reserved.    Contact GEMS    Updated November 15, 2020