1. Name and date of birth:

2. Academic rank: (State whether full-time, and if part-time indicate non-academic activity and percent of time devoted to it.) 3. Degrees with fields, institutions and dates: 4. Number of years service on this faculty, including date of original appointment and dates of advancement in rank:
5. Other related experience -- teaching, industrial, etc. - (what capacity, where,when?): 6. Honors and awards: 7. Other assigned duties performed during the academic year, with average hours per week. Indicate which carry extra compensation:



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