Name:
Mailing Address:
Email address:
Gender:
Citizenship:
(eg US National, Indian, Chinese, Polish, German, Egyptian, Turkish, Scottish, Australian... )
Visa Status:
(eg J1, H1,..., US National)
SU Academic Department affiliation:
(eg Physics, CIS,...)
Degrees earned:
(Name of Institution and Date awarded)
Current Academic Status at SU:
(eg doing masters, doing PhD)
Date Course Work Started:
Anticipated Comprehensive Examination Date:
Anticipated Masters graduation Date:
Anticipated PhD graduation Date:
Total Number of Tuition Hours to Complete Current Degree:
Number of Tuition Hours needed for Fall:
Number of Tuition Hours needed for Spring:
Number of Tuition Hours needed for Summer:
Name of NPAC Project leader:
(the NPAC person mainly associated with you and your work)
Full Name of Academic Advisor:
Full Name of Thesis/Dissertation Director:
Full Names of Thesis/Dissertation Committee Members:
List all Completed SU Courses and Grade Earned:
List all SU Courses you EXPECT to Take:
List your PhD Reading List (if applicable):
Dissertation Topic / Title:
(State whether this a Masters or Thesis Dissertation)
Career Goals:
(Please specify: Type of position sought eg computer applications area or computer development area; type of environment sought eg academia, research lab, industry and location eg USA, home country or other country)
Areas of your specialization:
(eg software, hardware, systems, algorithms, more detail if possible...indicate what you are good at and interested in)
Project assignments:
(Describe any special duties that you have outside thesis work that are currently assigned to you, eg Mosaic, HPFA, foils developement, software development for parallel systems, please give as much detail as possible...)
On what NPAC Main project(s) are you currently working:
Name of associated NPAC project leader(s):
On what NPAC Service activities are you currently working:
Name of associated NPAC project leaders:
List other NPAC activities you have worked on in the past which are not covered above:
Name of associated NPAC project leaders:
Type of research you expect to be working on for the next semester:
(describe giving as much detail as possible)
Any expected absences during the academic year:
(please describe reason and give dates where possible)
Approvals:
(Take the printed form to these people for their signatures)
NPAC Project Leader:
Thesis Dissertation Director:
Academic Advisor:
NPAC Director: