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PERSONAL DATA SHEET NBC 461

NOTE: THE FACULTY MEMBERS OF A STATE COLLEGE/UNIVERSITY WILL FILL THISFORM

INSTRUCTION:

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1.6 EDUCATIONAL 7UALIFICATION

1.1 HIGHEST RELEVANT ACADEMIC DEGREE OR EDUCATIONAL ATTAINMENT

AND ADDITIONAL E7UIVALENT DEGREE EARNED TO THE PRESENT POSITION.

DEGREE EARNED SPECIALIZATION INSTITUTION YEAR OBTAINED

1.2 ADDITIONAL CREDITS EARNED TOWARDS AN APPROPRIATE HIGHER

DEGREE

BACCALAUREATE MASTERAL DOCTORAL

2.6 E8PERIENCE AND LENGTH OF SERVICE

1.9 SERVICE RECORDED. INCLUDES FULLTIME TEACHING, RESEARCH,

E8TENSION SERVICE AND INDUSTRIAL E8PERIENCES

INCLUSIVE DATE POSITION HELD INSTITUTION ADDRESS

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9.6 PROFESSIONAL DEVELOPMENT, ACHIEVEMENT AND HONORS

NATURE OF INNOVATION/INVENTION PATENT NUMBER YEAR PATENTED

9.1.2 9.1.; PUBLISHED BOO

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9.2 E8PERT SERVICES, TRAINING AND ACTIVE PARTICIPATION IN

PROFESSIONAL/TECHNICAL ACTIVITIES

9.2.1 TRAINING COURSES AND SEMINARS (INCLUDING ACADEMIC, TECHNICAL,

INDUSTRIAL, AND FISHERY TRAINING)

A. TRAINING

TITLE OF TRAINING SPONSORING AGENCY LEVEL (INT=L,NAT=L, REG=L,

LOCAL, INST=L

INCLUSIVE

DATES

B. CONFERECES, SEMINARS, ETC.

TITLE OF CONFERENCE SPONSORING AGENCY INCLUSIVE DATES

9.2.2 E8PERT SERVICES

A. CONSULTANCY

NATURE/AREA OF

CONSULTANCY

COUNTRY SPONSORING AGENCY INCLUSIVE

DATES

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B. ACTIVE PARTICIPATINNG IN TRAININNG. WOR

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9.9 MEMBERSHIP IN PROFESSIONAL ORGANIZATION/HONORS SOCIETIES AND

HONORS RECEIVED

9.9.1 MEMBERSHIP IN PROFESSIONAL/HONOR SOCIETIES

NAME OF ORGANIZATION DATE OF MEMBERSHIP

9.9.2 ACADEMIC HONORS RECEIVED

HONORS RECEIVED DEGREE OBTAINED INSTITUTION ADDRESS

9.9.9 SCHOLARSHIP/FELLOWSHIP

TITLE OF

SCHOLARSHIP

NATURE (COMPETITIVE: INT=L,

NAT=L, REG=L, LOCAL) (NONCOMPETITIVE: INT=L, REG=L,LOCAL)

SPONSORING AGENCY INCLUSIVE

DATES

9.> AWARDS OF DISTINCTION RECEIVED IN RECOGNITION OF ACHIEVEMENT IN

RELEVANT AREAS OF SPECIALIZATION/PROFESSIONAL/ ASSIGNMENT

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TITLE OF AWARD

OF DISTINCTION

(INSTRUCTIONAL

MATERIALS)

FIELD OF

SERVICES

GRANTEE

ORGANIZATION

LEVEL: INT=L/

NAT=L/

REG=L/

LOCAL

DATE

9.; COMMUNITY OUTREACH: SERVICE ORIENTED PRO?ECTS PARTICIPATED IN THE

COMMUNITY

NAME OF PRO?ECT PARTICIPATION

SERVICE

SPONSORING AGENCY INCLUSIVEDATES

9.@ PROFESSIONAL E8AMINATIONSTITLE OF E8AMINATION RATING DATE

D. RESEARCH RECOMMENDATION TRANSFORMED TO PUBLIC POLICY

BENEFITING TO THE COUNRTY AND OTHER CREATIVE WOR

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COMPLETE TITLE OF

RESEARCH

LEVEL INT=L,

NAT=L, REG=L,

LOCAL, INST=L

SPONSORING AGENCY INCLUSIVE

DATES

E. SUPERVISION, TUTORING OR COACHING OF GRADUATE SCIENTISTS AND

TECHNOLOGIES

NATURE AREA OF

SUPERVISION /

TUTORING /

COACHING

COUNTRY SPONSORING

AGENCY

LEVEL: INT=L/

NAT=L/ REG=L/

LOCAL

INCLUSIVE

DATES

F. RESEARCH RESULTS APPLIED OR UTILIZED IN INDUSTRIAL AND/OR

COMMERCIAL PRO?ECTS OR UNDERTA

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COMPLETE TITLE OF

RESEARCH

LEVEL INT=L,

NAT=L, REG=L,

LOCAL, INST=L

SPONSORING AGENCY INCLUSIVE

DATES

I HEREBY CERTIFY TO THE CORRECTNESS AND ACCURACY OF THE STATEMENTS.

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