**Application Instructions**

**General Requirements**

1.  An applicant must be a full-time permanent faculty member at an
    accredited U.S. college or university.

2.  There are no citizenship requirements.

A complete application consists of:

1.  Application form

2.  Current vitae

3.  Description of current and previous research

4.  Two references (forms preferred)

5.  Certification of salary form

6.  Copy of permanent resident alien card (PRA)

7.  Applicant data form

**Additional Requirements**

1.  **An applicant for a sabbatical appointment** must include a
    statement describing the financial arrangements with their academic
    institution, including fringe benefits paid by the institution.
    State as a percentage of salary and itemize.

2.  **An applicant for a part-time appointment** needs to submit a
    signed Part-Time Approval Form.

3.  **An applicant to a fossil energy facility** must provide a detailed
    statement of the educational objectives and benefits to be realized
    as a result of the appointment.

**Application Deadline**

The application is always open, but for best results, apply by February
15 for summer appointments.

**All application materials should be sent directly to the address
below:**

Truly Ani

NETL Faculty Research Participation Program

Oak Ridge Institute for Science and Education

Science Education Programs, MS 36

P.O. Box 117

Oak Ridge, TN 37831-0117

**Phone:** (865) 574-6912 **Fax:** (865) 574-2850 **E-mail:**
Truly.Ani@orau.org

**Overnight Express Delivery Address:**

ATTN: Truly Ani, MS-36, 1299 Bethel Valley Road, Building SC-200

Oak Ridge, TN 37830

**Participating Research Facilities**

National Energy Technology Laboratory, Pittsburgh, Pennsylvania

National Energy Technology Laboratory, Morgantown, Pennsylvania

Albany Research Center, Albany, Oregon

**Application Form**

  ------------ ----------------------- ----------------- -----------------
  **Choice of                          **Type of         
  Facility**                           Appointment**     
                                       (check one)       

  First choice                         Summer            Part Time

  Second                               Sabbatical        (additional form
  choice                                                 required)
  ------------ ----------------------- ----------------- -----------------

  --------------- ----------- ------------------ ---- --------------------- ------------------
  **Requested                                    to                         (Month/Day/Year)
  Dates** From                                                              

                                                                            

  **Name**        **     **                                                 
  (First, Middle,                                                           
  Last)                                                                     
  --------------- ----------- ------------------ ---- --------------------- ------------------

  ----------------- ------------------- ---------------- -----------------------
  **Institution**   **     **           **Department**   **     **

  **Department      **     **           **Office Phone** **     **
  Phone**                                                

  **E-mail          **     **           **Office Fax**   **     **
  Address**                                              
  ----------------- ------------------- ---------------- -----------------------

  ----------------- ----------- ------ ----------- ----------- ----------- ------------------- ----------- -------------
  **Office Mailing                     **     **                                                           
  Address**                                                                                                

                                       (Street                                                             
                                       Name,                                                               
                                       Apartment                                                           
                                       Number, or                                                          
                                       P.O. Box)                                                           

  **     **                                                    **     **                                   **     **

  City State Zip                                                                                           

  **Permanent                                      **     **                                               
  Mailing Address**                                                                                        

                                       (Street                                                             
                                       Name,                                                               
                                       Apartment                                                           
                                       Number, or                                                          
                                       P.O. Box)                                                           

  **     **                                                    **     **                                   **     **

  City State Zip                                                                                           

  **Home Phone**    **     **                                                                              

                                                                                                           

  **Citizenship**               Yes No                                     If no, country of   **     **   
  U.S. Citizen                                                             citizenship:                    

  If no, Permanent              Yes No                                                                     
  Resident                                                                                                 
  ----------------- ----------- ------ ----------- ----------- ----------- ------------------- ----------- -------------

Foreign nationals, please provide:

  -------- -------------------------- --------------- --------------------
  Visa                                Visa Expiration      
  Type                                Date            

  -------- -------------------------- --------------- --------------------

**Education**

  ----------------- ----------------- -------------------- -----------------
  Highest Degree    Major             Institution/Campus   Date
  Earned                                                   

                                                                
  ----------------- ----------------- -------------------- -----------------

Employment Record

  -------- -------- ------------------- --------------- ---------------------
  From     To       Employer            Position/Rank   Nature of work

                                                             

                                                             

                                                             
  -------- -------- ------------------- --------------- ---------------------

List two professional references who have been asked to transmit
recommendations directly to ORISE.

  ----- -------------------------------- ----- --------------------------------
  1\.                                    2\.        

  ----- -------------------------------- ----- --------------------------------

List members of facility scientific staff with whom you have had
contact.

  ----- -------------------------------- ----- --------------------------------
  1\.                                    2\.        

  ----- -------------------------------- ----- --------------------------------

I am interested in having my application considered for similar
programs. Yes No Yes, but call me first.

**Application, page 2**

**Release and Certification of Accuracy** (Please print and sign.)

I understand that the information in the application and the references
will be provided to the respective staff involved in the selection
process, and that the demographic data will not be used for selection
purposes.

I certify that all of the information I have provided in this
application is true and accurate to the best of my knowledge. I
understand that any falsification will render me ineligible for
participation and, if found after participation has begun, will require
me to reimburse any funds received.

-   Yes, I have read the above statements and certify that the
    information in my application is accurate.

  ------------- ---------------------------------------------------------
  Date          
  Certified:    

  Applicant     
  Signature:    
  ------------- ---------------------------------------------------------

**Reference Letter**

  ---------------------- ---------------- --------------------------------
  Applicant Name (Last,                   
  First, Middle)                          

  How long and in what                         
  association have you                    
  known this applicant?                   

                                          
  ---------------------- ---------------- --------------------------------

Your comments on this applicant:      

+--------------+-------------------+---------+----+-------------------+
| Signature    |                   |         | Da |                   |
|              |                   |         | te |                   |
+--------------+-------------------+---------+----+-------------------+
| T            |                   |         |    |                   |
| yped/Printed |                   |         |    |                   |
| Name         |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+
| Address      |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+
|              |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+
| **Return     |                   | **Ov    |    |                   |
| to:**        |                   | ernight |    |                   |
|              |                   | Add     |    |                   |
| Truly Ani,   |                   | ress:** |    |                   |
| MS-36        |                   |         |    |                   |
|              |                   | ATTN:   |    |                   |
| NETL Faculty |                   | Truly   |    |                   |
| Research     |                   | Ani,    |    |                   |
| P            |                   | MS-36   |    |                   |
| articipation |                   |         |    |                   |
|              |                   | > 1299  |    |                   |
| Oak Ridge    |                   | >       |    |                   |
| Institute    |                   |  Bethel |    |                   |
| for Science  |                   | >       |    |                   |
| and          |                   |  Valley |    |                   |
| Education    |                   | > Road  |    |                   |
|              |                   |         |    |                   |
| P.O. Box     |                   | B       |    |                   |
| 117,         |                   | uilding |    |                   |
|              |                   | SC-200  |    |                   |
| Oak Ridge,   |                   |         |    |                   |
| TN           |                   | Oak     |    |                   |
| 37831-0117   |                   | Ridge,  |    |                   |
|              |                   | TN      |    |                   |
| **Phone:**   |                   | 37830   |    |                   |
| (865)        |                   |         |    |                   |
| 574-6912     |                   |         |    |                   |
|              |                   |         |    |                   |
| **Fax:**     |                   |         |    |                   |
| (865)        |                   |         |    |                   |
| 574-2850     |                   |         |    |                   |
|              |                   |         |    |                   |
| **E-mail:**  |                   |         |    |                   |
| Truly.       |                   |         |    |                   |
| Ani@orau.org |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+

Reference Letter

  ---------------------- ---------------- --------------------------------
  Applicant Name (Last,                   
  First, Middle)                          

  How long and in what                         
  association have you                    
  known this applicant?                   

                                          
  ---------------------- ---------------- --------------------------------

Your comments on this applicant:      

+--------------+-------------------+---------+----+-------------------+
| Signature    |                   |         | Da |                   |
|              |                   |         | te |                   |
+--------------+-------------------+---------+----+-------------------+
| T            |                   |         |    |                   |
| yped/Printed |                   |         |    |                   |
| Name         |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+
| Address      |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+
|              |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+
| **Return     |                   | **Ov    |    |                   |
| to:**        |                   | ernight |    |                   |
|              |                   | Add     |    |                   |
| Truly Ani,   |                   | ress:** |    |                   |
| MS-36        |                   |         |    |                   |
|              |                   | > ATTN: |    |                   |
| NETL Faculty |                   | > Truly |    |                   |
| Research     |                   | > Ani,  |    |                   |
| P            |                   | >       |    |                   |
| articipation |                   |  MS-36\ |    |                   |
|              |                   | > 1299  |    |                   |
| Oak Ridge    |                   | >       |    |                   |
| Institute    |                   |  Bethel |    |                   |
| for Science  |                   | >       |    |                   |
| and          |                   |  Valley |    |                   |
| Education    |                   | > Road  |    |                   |
|              |                   |         |    |                   |
| P.O. Box     |                   | B       |    |                   |
| 117,         |                   | uilding |    |                   |
|              |                   | SC-200  |    |                   |
| Oak Ridge,   |                   |         |    |                   |
| TN           |                   | Oak     |    |                   |
| 37831-0117   |                   | Ridge,  |    |                   |
|              |                   | TN      |    |                   |
| **Phone:**   |                   | 37830   |    |                   |
| (865)        |                   |         |    |                   |
| 574-6912     |                   |         |    |                   |
|              |                   |         |    |                   |
| **Fax:**     |                   |         |    |                   |
| (865)        |                   |         |    |                   |
| 574-2850     |                   |         |    |                   |
|              |                   |         |    |                   |
| **E-mail:**  |                   |         |    |                   |
| Truly.       |                   |         |    |                   |
| Ani@orau.org |                   |         |    |                   |
+--------------+-------------------+---------+----+-------------------+

**Certification of Salary**

**To Be Completed By Applicant**

  ------ ------------------------------ ------------- -------------------------
  Name                                  Institution        

  ------ ------------------------------ ------------- -------------------------

  ------------ ----------------------- ----------------- -----------------
  **Choice of                          **Type of         
  Facility**                           Appointment**     
                                       (check one)       

  First choice                         Summer            Part Time

  Second                               Sabbatical        
  choice                                                 
  ------------ ----------------------- ----------------- -----------------

Does the applicant want this document to be privileged information? Yes
No

Disclosure of this information is made subject to Public Law 93-579 (the
Privacy Act of 1974) and U.S. Department of Energy regulations as
published in the Federal Register on September 30, 1997.

**To be completed by the institutional administrative office:**

Applicant's employment contract with this institution is: full time part
time

  ------------------ ----------------- --------------- -------------------
  Months of required                   Academic salary      
  service                              ends            

  Base academic                                             
  salary for                                           
  required service                                     
  excluding all                                        
  fringe benefits                                      

  Do not include                                       
  extra pay for                                        
  summer school                                        
  teaching, overtime                                   
  teaching, special                                    
  payment for                                          
  contract work,                                       
  consultant fees,                                     
  or any other                                         
  compensation not                                     
  covered by the                                       
  contract.                                            
  ------------------ ----------------- --------------- -------------------

Does the institution want this document to be privileged information?
Yes No

Disclosure of this information is made subject to Public Law 93-579 (the
Privacy Act of 1974) and U.S. Department of Energy regulations as
published in the Federal Register on September 30, 1997.

For faculty employed for more than 10 or more months per year, provide a
statement of the institutional policy regarding participation in outside
activities for which a gratuity may be provided.

For faculty applying for sabbatical appointments, include a statement
describing the financial arrangements with the institution, including
fringe benefits paid by the institution. State as a percentage of salary
and itemize.

  ---------------- ------------------------------ ------- -----------------
  Signature                                       Date    

  Typed Name and                                  Phone        
  Title                                                   

  Address                                                 
  ---------------- ------------------------------ ------- -----------------

+-----------------------------------+-----------------------------------+
| **Return to:**                    | **Overnight Address:**            |
|                                   |                                   |
| Truly Ani, MS-36                  | ATTN: Truly Ani, MS-36            |
|                                   |                                   |
| NETL Faculty Research             | > 1299 Bethel Valley Road         |
| Participation                     |                                   |
|                                   | Building SC-200                   |
| Oak Ridge Institute for Science   |                                   |
| and Education                     | Oak Ridge, TN 37830               |
|                                   |                                   |
| P.O. Box 117,                     |                                   |
|                                   |                                   |
| Oak Ridge, TN 37831-0117          |                                   |
|                                   |                                   |
| **Questions?**                    |                                   |
|                                   |                                   |
| **Phone:** (865) 574-6912         |                                   |
|                                   |                                   |
| **Fax:** (865) 574-2850           |                                   |
+-----------------------------------+-----------------------------------+

**Applicant Data**

Applicant data is important in assessing the effectiveness of our
efforts to solicit applications from a diverse population. Your
completion and submission of this form will assist us in this regard.
Providing this information is voluntary. If you decline to give this
information, it will in no way affect consideration of your application.

  ------ ----------------------------------------- ------ ------------------
  Name                                             Date        

  ------ ----------------------------------------- ------ ------------------

Race

Caucasian (Having origins in any one of the original peoples of Europe,
North Africa, or the Middle East)

African-American (Having origins in any Black racial groups of Africa)

Hispanic (of Mexican, Puerto Rican, Cuban, Central/South American or
other Spanish culture of origin, regardless of race)

American Indian (Having origins in any of the original peoples of North
America, and maintaining cultural identification through tribal
affiliation of community recognition)

Asian or Pacific Islander (Having origins in any of the original peoples
of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific
Islands --- for example, India, China, Japan, Korea, Philippine Islands,
and Samoa)

  ------- -----------------------------------------------------------------
  Other        

  ------- -----------------------------------------------------------------

Gender

Female Male

  -------- --------------------------------------------------------------
  Birth         
  Date     

  -------- --------------------------------------------------------------

Physical/mental handicap (physical or mental impairment that
substantially limits one or more major life activities, for example,
blindness, deafness, or mobility impairment) Yes No

+-----------------------------------------------------------------------+
| **Return to:** Truly Ani, MS-36, ORISE, P.O. Box 117, Oak Ridge, TN   |
| 37831-0117                                                            |
|                                                                       |
| **Phone:** (865) 574-6912 **Fax:** (865) 574-2850 **E-mail:**         |
| Truly.Ani@orau.org                                                    |
+-----------------------------------------------------------------------+