XV. Curriculum Vitae and Bibliography Format for all Faculty

PART I: General Information

DATE PREPARED:

Name:

Office Address:

Home Address:

Work E:Mail: Work FAX:

Place of Birth:

Education:

Year Degree Institution

For graduate degrees, note field or discipline.

Postdoctoral Training:

Year Title Specialty/Discipline Place of Training

List here all internships, residencies, clinical and research fellowships.

Licensure and Certification:

Year Type of License or Certification

Registration numbers are not needed.

Academic Appointments:

Year Academic Title Institution

Hospital or Affiliated Institution Appointments:

Year Title Hospital/Affiliated Institution

Other Professional Positions and Major Visiting Appointments:

Year Position/Title Institution

List only those positions that are related to the appointee's professional field.

Hospital and Health Care Organization Service Responsibilities:

Year Role Institution/Organization

Major Administrative Responsibilities:

Year Title Institution (local, government, foundation)

Major Committee Assignments:

Year Name of Committee Role Institution

These should be grouped under headings of Medical School/School of Dental Medicine, Affiliated Institution, Regional, or National. Indicate if appointee¹s role was chairperson or secretary.

Professional Societies:

Year Society Role (e.g., member, officer, committee assignment)

Community Service Related to Professional Work:

Year Position/Title Role Institution

Editorial Boards:

Year Role (e.g., editor, member, ad hoc reviewer) Name of Journal

Awards and Honors:

Year Name of Award