Art of Science Participant Form | Carl R. Woese Institute for Genomic Biology

Thank you for agreeing to participate in the Art of Science: Images from the Institute for Genomic Biology exhibition. The Art of Science represents fulfilling all three of the University of Illinois’ missions: public engagement /research/education. Community members learn about some of the university’s research. Middle to high school students interact with scientists who create the images. Graduate student are introduced to each other with the possibility of increasing their collaborations in the lab. The Art of Science series is a shining example of the university’s commitment to a comprehensive public university.

Please complete this form so we have the correct information for the poster, handout, website, and publicity purposes.

Your name

Please type name as you would like it to appear listed with the piece.

Your Title

Email

Collaborator names (List people you would like credited when the image is on display)
Collaborator names (List people you would like credited when the image is on display)

What is this Image?

Home Unit or Department:

Lab Name or Principal Investigator

If you are not the PI, then have you confirmed with him/her that you have permission to participate?: *

Lab website address:

Instrument Name or process/program used to create image:

At what magnification was this image acquired?

Describe what is seen in this image:

Why is this image and research important to society?:

Please write a brief description at the pop science and non-technical level for the general public. It may be edited due to space and printing constraints.

This research is funded by:

Please list any agencies, companies, etc that helped fund this research.

The IGB is occasionally asked if researchers are interested in talking with middle to high school students about their research from the images.

Would you be interested in talking with students during the Art of Science exhibition at the gallery?

Would you be interested in talking with students during the school year?

If yes, then Claudia Lutz or Julia Pollack will contact you to give you details and to ask if you are available.

Questions?

Claudia Lutz
IGB Outreach Manager
cclutz2@illinois.edu

or
Julia Pollack
IGB Creative Manager
jpollac2@illinois.edu

By submitting the form I do hereby consent to the use by the Institute for Genomic Biology and the University of Illinois at Urbana-Champaign of the image and information regardless of whether these materials are used for publicity or any other purpose on behalf of either the university or its Foundation.

Thank you! We hope to see you at the opening reception!