Workshop on Information Assurance Education
                     University of Houston, Houston, TX
                          Participant Application
                         =========================

Please fill out and email to rverma@uh.edu. Your registration will 
be complete when you receive a confirmation to your email. 

1. Name:

2. Employment

   Current position:

   Department:

   Email:

   Contact phone number:


3. Name and Address of your Institution: 







4. Mailing address (if different from above)






5. What is the highest degree awarded by your department?


6. List the names of Information Technology or Computer Science Courses
   that you have taught during the last two years. (For prospective 
   faculty, list names of up to 3 courses you expect to teach within
   the next two years.)









7. Please provide a brief description of your interest in Information
Assurance Education. In addition, you may optionally attach your CV. Since
workshop space is limited, we may have to deny some applications for
registration. In that case, your description will serve as the basis for
our decision.















8. If you are interested in financial assistance, please provide the
   following information regarding anticipated expenses:

   Travel: Please specify origin, destination, mode of
           transport and expected cost.

   Other: Please specify any other expenses you anticipate and
          the expected cost.


9. I certify that all of the above information is accurate. 
(Please type your name below to acknowledge that you agree to (9).)