ERN 2020 Video Contest Entry Form General InformationName* First Last Enter the name of the contestant or the team leader of a group of contestants.Email* Enter Email Confirm Email Please enter the primary contact e-mail address for this submission.Institution* What college or institution do you attend or are affilitated with?Class Designation*UndergraduateGraduateYear of Study*1234+Discipline of Study* Biology Chemistry and Chemical Sciences Computer Sciences and Information Management Environmental and Earth Sciences Mathematics and Statistics Nanoscience Physics Mathematics Educatio Social, Behavioral, and Economic Sciences Technology and Engineering NSF Affilitation* AGEP CREST EntryPoint HBCU-UP LSAMP RDE REU TCUP EFRI-REM Other None Team InformationIs This a Team Submission?* Yes No Team Name Please designate your group's nameHow many team members does your group consist of?*Please enter a number from 2 to 6.Team Member #2* First Last Team Member #2 E-mail* Team Member #3* First Last Team Member #3 E-mail* Team Member #4* First Last Team Member #4 E-mail* Team Member #5* First Last Team Member #5 E-mail* Team Member #6* First Last Team Member #6 E-mail* Video InformationYouTube/Vimeo URL* Please enter the full address in the field providedDiscipline* Please define the discipline(s) your video focuses on.Video DescriptionProvide a brief description and/or summary of your video here.Demographic InformationAll demographic information you provide is confidential and will be used only for evaluation purposes by the collaborating organizations and the evaluator for the purpose of analyzing data, preparing reports and articles, and selecting samples for a limited number of carefully defined follow-up studies. Any information publicly released (such as statistical summaries) will be in a form that does not personally identify you or your institution. Your response is voluntary and failure to provide some or all of the requested information will not in any way adversely affect you.Gender* Male Female Decline to Disclose Ethnicity* American Indian or Alaskan Native Asian Black or African American Hispanic White Decline to Disclose Disability Status* Hearing Impairment Visual Impairment Mobility/Orthopedic Impairment Other None Please describe in the text box below:** I have read the rules and confirm that I am eligible to participate in this contest and agree to the terms and conditions set forth in the provided rules. (https://emerging-researchers.org/ern2020-video-rules/) * I agree to allow my name and my photo to be used and printed on the ERN Conference website, in the Conference Program Book, and other conference related materials. Note: Selecting 'YES' gives the ERN Conference Committee formal permission to publish your photo. PhoneThis field is for validation purposes and should be left unchanged.
