Form DOE F 360.10 DOE F 360.10 WORKFORCE DEVELOPMENT HIGHLIGHTS FORM

DOE F 360.10 (08/2022) All other editions are obsolete

U.S. DEPARTMENT OF ENERGY OFFICE OF WORKFORCE DEVELOPMENT FOR TEACHERS AND SCIENTISTS (WDTS) WORKFORCE DEVELOPMENT HIGHLIGHTS FORM

OMB Control No. Exp. Date

OMB BURDEN DISCLOSURE STATEMENT This data is being collected to provide prospective applicants with insight to the experience of participants in the Department of Energy’s Office of Science (SC) Office of Workforce Development for Teachers and Scientists (WDTS) internship programs. The data you supply will be used for creating outreach materials for publication to the WDTS website and SC social media accounts. Public reporting burden for this collection of information is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Enterprise Policy Development & Implementation Office, IM-22, Information Collection Management Program (enter OMB control number), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC 20585; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (enter OMB control number), Washington, DC 20503. Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Submission of this data is voluntary.
INSTRUCTIONS Thank you for taking the time to answer the following questions about your experience as a Science Undergraduate Laboratory Internships (SULI), Community College Internships (CCI), or Visiting Faculty Program (VFP) participant at the Department of Energy (DOE) National Labs, and your related academic and/or career experience! Your responses will allow prospective applicants to understand the breadth of research topics available to them at a National Lab, what working at a National Lab is like, and what possibilities SULI, CCI, and VFP placements can unlock for them in the future. In short, your responses are invaluable for helping prospective applicants see themselves at that National Labs. After asking some basic information about where and when you were a SULI, CCI, or VFP participant, the form consists of five required and two optional short response questions. At the end, you will be asked to provide 1-2 images of yourself.
SECTION I: PERSONAL INFORMATION
First Name:		Last Name:
Email:
SECTION II: PLACEMENT INFORMATION
At which National Lab(s) or site(s) were you placed?
☐ Ames Laboratory ☐ Argonne National Laboratory ☐ Brookhaven National Laboratory ☐ Fermi National Accelerator Laboratory ☐ General Atomics / DIII-D Facility ☐ Idaho National Laboratory ☐ Lawrence Berkeley National Laboratory ☐ Lawrence Livermore National Laboratory ☐ Los Alamos National Laboratory		☐ National Renewable Energy Lab ☐ Oak Ridge National Laboratory ☐ Pacific Northwest National Laboratory ☐ Princeton Plasma Physics Laboratory ☐ Sandia National Laboratories ☐ Savannah River National Laboratory ☐ SLAC National Accelerator Laboratory ☐ Thomas Jefferson National Accelerator Facility
Which program(s) did you complete?
☐ SULI	☐ CCI		☐ VFP
What year(s) did you participate in the program(s)? Please provide your response in the format YYYY, e.g., 2022.
What was your research topic during your placement(s)? Please describe your research topic as you would to a non-scientist friend or family member. What excites you about this topic, or why is it important?
Please list and, where possible, provide links to any publications or presentations at professional conferences resulting from your internship.
What was it like working at a National Lab? Please describe how the Lab was similar and/or different to your home institution, both academically and socially. How did you handle the transition?
Which of the following best describes you? ☐ I am a past or current SULI, CCI, or VFP student participant. I am a current undergraduate student, or I graduated from an undergraduate program less than two years ago. ☐ I am a past SULI, CCI, or VFP student participant. I graduated from an undergraduate program more than two years ago. ☐ I am a past or current VFP faculty participant.
SECTION III - UNDERGRADUATES AND RECENT GRADS
What are your hopes for your career?
Think of a time you experienced success during your internship. What did this success look like? For example, you could discuss what actions you took or decisions you made that contributed to this success, or how you personally developed as a result this experience.
Think of a time you experienced failure during your internship or academic career. How did you feel at the time? How did you deal with the failure and work past it?
Describe a concern you had while considering or applying to the internship. What advice would you give to help a student with the same concern today?
SECTION IV- TWO OR MORE YEARS OUT FROM UNDERGRAD
What do you currently do, and where do you hope your career takes you?
Think of a time you experienced success during your academic or professional career. What did this success look like? For example, you could discuss actions you took or decisions you made that contributed to this success, or describe how you personally developed as a result of the experience.
Think of a time you experienced failure during your academic or professional career. How did you feel at the time? How did you deal with the failure and work past it?
SECTION V – FACULTY
How did your VFP placement impact your career? Please describe any impacts on both your research and teaching, if applicable.
What advice would you give to another faculty member considering applying to VFP?
SECTION VI - OPTIONAL QUESTIONS
What personal connections in your life are most important to you? Did you make any important personal connections during your placement? If so, can you describe these connections and what they mean to you?
What are your values? How are your values expressed through your academic or professional career?
SECTION VI - ADDITIONAL DOCUMENTS/INSTRUCTIONS
For your submission to be considered complete, please email: Two high-resolution pictures of yourself. At least one image of yourself in a research, academic, or career setting is highly encouraged. Images must be JPEG or TIFF format, with a minimum resolution of 150 dpi; 300 dpi is preferred. Please email pictures to: SC.WDTS@science.doe.gov with the subject line: "WDTS Workforce Development Highlights."
CONSENT STATEMENT
Please note, by submitting this form, you grant the DOE Office of Workforce Development for Teachers and Scientists (WDTS), which manages the SULI, CCI, and VFP programs, permission to use your written responses and any provided images in WDTS promotional materials, including, but not limited to, the DOE WDTS website and social media originating from DOE-owned accounts. Written responses may be edited for grammar, clarity, and length prior to use. Please also note that not all submissions may be used. ☐ I understand my data will be held securely and will not be distributed to third parties. ☐ I have a right to change or access my information. ☐ I understand that when this information is no longer required for this purpose, official procedure will be followed to dispose of my data.
First Name:		Last Name:
Signature:		Date: