NY6 Speaker Form

New York Six Scholar-Teacher Network

Connecting Member Institutions with Faculty Scholar-Teachers
Faculty Information
Thank you for volunteering to serve as a New York Six Scholar-Teacher. Please complete each tab completely before submitting. If you have any questions, please contact Amy Cronin at acronin@newyork6.org.

*Required Field
Name *

First Name Middle Name Last Name
Job Title *
Academic Department (s) and/or Program (s) *
Institution *
Campus Phone Number *
I give permission for my phone number to be placed on the New York Six Scholar-Teacher Network website. *

Yes No
E-mail *
I give permission for my email address to be placed on the New York Six Scholar-Teacher Network website. *

Yes No
Website Address (if applicable)
I give permission for my website address to be placed on the New York Six Scholar-Teacher Network website.

Yes No
Upload Bio *
Please upload a 100-200 word bio to be used on the program website. Word documents preferred.

Areas of Expertise
Areas of Expertise

Please explain what you are willing to share on campus visits. This explanation could include titles of presentations or descriptions of the types of events you are willing to share (e.g. music master class, scientific techniques workshop). The explanation may also include a description of your areas of expertise.
Areas of Expertise *
Keywords

Please additionally provide 2-3 keywords or phrases that will help potential hosts find speakers and lectures on our website.
Keyword *
Keyword *
Keyword
Other
Other lecture titles or keywords may be entered in the space below.

New York Six Scholar-Teacher Network