APS Site Visit Request Form
This document must be submitted by the chair or their equivalent within national labs or scientific collaborations.
Please use this form to request an APS site visit to assess the climate for women and/or individuals from marginalized groups in your organization. Most site visits happen at least 9 months after the initial request is made. All data collected during the site visit is kept confidential; reports do not contain any identifying information of organizational members. The final report and recommendations are given to the departmental team for their use and consideration.
*
1.
Email
(Required.)
*
2.
Name
(Required.)
*
3.
Phone
(Required.)
*
4.
Name of institution/department/lab/organization
(Required.)
*
5.
Title
(Required.)
*
6.
Have you had a previous site visit?
(Required.)
Yes
No
7.
If you have had a previous site visit, what year did it take place?
8.
If you have had a previous site visit, please provide a brief description of measures taken since the visit.
*
9.
Provide a rough timeline for the requested site visit (Spring, Summer, Fall, Winter). Note: This must be at least 9 months from date of request.
(Required.)
*
10.
What is the approximate number of tenure track/tenured faculty or permanent scientists for non-academic departments?
(Required.)
*
11.
What is the approximate number of postdocs/research scientists?
(Required.)
*
12.
What is the approximate number of non tenure track faculty/teaching faculty/lecturers?
(Required.)
*
13.
What is the approximate number of graduate students?
(Required.)
*
14.
What is the approximate number of undergraduate students?
(Required.)
*
15.
What is the approximate number of staff members?
(Required.)
*
16.
Please provide a brief rationale of why you would like a site visit. What is your current situation? What is the motivation for this request? What do you hope to achieve from this site visit?
(Required.)
