Academic Family Tree Information

(also include a 1-page cv)

YOUR NAME:

ADDRESS:

FAX:

TELEPHONE:

EMAIL:

PLACE AND YEAR OF BIRTH:

YOUR PHD DEGREE INFORMATION

INSTITUTION:

MOST SIGNIFICANT ADVISOR:

YEAR:

TITLE OF DISSERTATION:

LIST OF MS AND PHD GRADUATE STUDENTS FOR WHOM YOU SERVED AS MAJOR PROFESSOR WITH THEIR ADDRESSES (INCLUDING EMAIL) AND YEAR OF GRADUATION:

Name Degree&Year Postal Address Email Address

__________________________________________________________________________________________

YOUR ADVISOR(S):

NAME:

CONTACT ADDRESS:

FAX:

TELEPHONE:

EMAIL:

ADDITIONAL INFORMATION YOU LIKE TO SHARE: