Personal Information: (Required fields*) Prefix Ms. / Mrs. / Mr. *First ...
Personal Information: (Required fields*) Prefix Ms. / Mrs. / Mr. *First ...
Personal Information: (Required fields*) Prefix Ms. / Mrs. / Mr. *First ...
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<strong>Personal</strong> <strong>Information</strong>:(<strong>Required</strong> <strong>fields*</strong>)<strong>Prefix</strong> <strong>Ms</strong>. / <strong><strong>Mr</strong>s</strong>. / <strong>Mr</strong>.<strong>*First</strong> Name: _______________*Last Name: _______________Suffix: ________*Rank (i.e. Professor _____________)College: ______________________Profile*Department: ___________________*Title (i.e. Dean): _____________________Tenured: Y / NCampus Mailing Address: _______________Department Phone/FAX: ____________/______________Mobile phone: _____________________________*Primary E-mail Address: _______________________________Alternate E-mail Address: _____________________________<strong>Personal</strong> Webpage or website*Gender: M / F*Ethnic Origin: _____________________*U.S. Citizen (Yes / No)*Permanent Resident (Yes / No)Security Class: ________Languages: _________________________Status: Active / RetiredExpertise <strong>Information</strong>:*Degree: ______________*Specialty / Major: ______________*Year: ______*School: _____________________Research Interests / Capabilities: ______________Keywords: __________________________________(see pick list)
Publications:1st Publication- Author/Authors___________________________________________________- Publication (name of book) Year:______________________________ ______2nd Publication- Author/Authors- Publication (name of book) Year:______________________________ _______Additional Publications:- Author/Authors- Publication (name of book) Year:______________________________ _______- Author/Authors- Publication (name of book) Year:_____________________________________Honors:___________________________________________________________________________________Professional Societies:____________________________________________________________________________________Awards:____________________________________________________________________________________Patents:_______________________________________________________________________________________________________________________________________________________________________
Current/Future Research Project Intent (Describe/attach pages):______________________________________________________________________________________________________________________________________________________________________
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