Biosketch*

Please provide a short biosketch of your professional background and research interests (one
paragraph). 1500 characters

Poster Abstract* 2,000 characters

Degree, Focus Area, Year Obtained, Name of Institution, Country 1000 characters

Description of current job responsibilities* 2000 characters

 name of your position

 employing institution
 start and end date (mm/yyyy - mm/yyyy)

Previous Professional position 1

200 charactors

Previous Professional position 2

200 charactors

Types of Awards and Honors Received*

Please select all the honors or awards that you have achieved.
Institution/University award
Research award
Teaching award
Government award
Undergraduate Scholarship
Graduate Scholarship
Training Scholarship
Conference Scholarship
Travel Grant
 Fellowship
Elected into professional science academy
AAS Fellow
AAS Affliate
List of Awards and Honors
Use the text area below to list, on a separate line beginning with the most recent, the honors and
awards that you have received. Please specify the name of the award, date received, and any
additional information you would like to share.

3,000 characters left of 3,000

Please list your 5 most significant publications (starting with the most recent) and be consistent
with the reference style you use to list your publications.

Publication 1
Publication 1
Publication 1
Publication 1
Publication 1

Please list your 5 most recent conference presentations. Include title of the presentation, name of
conference, date, and location. 

Presentation 1*

List of membership and professional societies*

Please list the membership and professional scientific organizations to which you belong. List any
leadership positions you hold or have held in the past. Each organization should be listed on a separate
line.

1,000 characters left of 1,000

International Collaboration

Please describe the collaborations you hope to develop as a result of the US-Africa Frontiers for
Science, Engineering, and Medicine symposium. Include any previous successful international
collaboration efforts you have participated in and your experience involved with such efforts.
This may include for example research collaborations, organizing conferences with international
partners, or developing student exchange programs.

3,000 characters left of 3,000

Travel Expenses

If necessary, will you be able to cover your airfare?*

Please note that most travel and accommodations will be covered and the answer to this question
will not affect the selection process.

Yes
No

Additional Information

English proficiency*
Please note the symposium will be held entirely in English.

Native
Fluent
 Advanced
Intermediate
Beginner
How did you learn about the US-Africa Frontiers Program?*
You can select more than one answer if applicable

E-mail from the U.S. National Academies of Sciences, Engineering, and Medicine
(NASEM)
E-mail form the African Academy of Sciences
E-mail from a U.S. Government agency (ONRG, NSF, USAID...)
Your university/institution
Press releases
Social Media (Twitter/Facebook)
Your personal network
Email from other
Have you previsously been selected to participate in a Frontiers symposium?*
Yes
No
If yes, please indicate which type of Frontiers meeting you attended in the past?
You can select more than one answer if applicable
Arab American Frontiers of Science, Engineering and Medicine
Frontiers of Science
Frontiers of Engineering
If yes, please indicate your role in previous Frontiers meetings?
You can select more than one answer if applicable
Participant
Speaker
Organizing committee member
Once your application is complete, remember to click on the "Submit Application" button. For
more information on the program, please visit our website. If you have any question, please e-
mail us at USAfricaSTEM@nas.edu.