PROMISE

First Anual Research Symposium
(*denotes required fields)

CONTACT INFORMATION
Title:
   Mr.    Miss    Ms.    Mrs.  
*Last Name:
*First Name:
Middle Name:
*Phone Number:
(xxx)xxx-xxxx
*Email Address:
*Mailing Address:
City:   State: Zip:

PERSONAL INFORMATION
*Gender:
US Citizen:
Race &/or Ethnic Origin: If Other,  please specify

PLEASE NOTE:  NSF requests demographic information for all graduate students involved in PROMISE activities.  Thank you for assisting in our efforts!

CURRENT EDUCATION INFORMATION
*Educational Institution & Department: UMB    
UMBC  
UMCP  
*Current Student Status:
*PROMISE Affiliation:
*Graduate Program Advisor Name:
*Graduate Program Advisor Email:
*Degree Objective

PhD and/or MD - Are you a Doctoral Candidate?
Masters (MA or MS)

RESEARCH SYMPOSIUM INFORMATION
*Type of Presentation:

*Research Division :

*Abstract Title:

*Abstract:
*Authorship:

 
Faculty Research Mentor and/or Principle Investigator (if different than your Graduate Program Advisor):
Name:
Email:

Group Research: list names of additional authors if applicable

*Equipement Needed:

LCD Projector
PowerPoint
VCR
Overhead Projector
Slide Projector
Stereo
Other - please specify:

Other Special Needs (please list)

Comments/Questions/Concerns

If you have any questions regarding this registration form, please contact Gloria Anglon via email at ganglon@gradschool.umd.edu or by phone at 301.405.4183.

PROMISE • Maryland's Alliance for Graduate Education and the Professoriate
Lead Institution: University of Maryland, Baltimore County • 1000 Hilltop Circle • Baltimore, MD 21250 • 410-455-2930 • promise@umbc.edu
University of Maryland Baltimore • Baltimore, MD  •
University of Maryland College Park • 2108 Lee Building • College Park, MD  20742 • 301.405.4180 • promise@gradschool.umd.edu
Page Last Updated:  Friday, November 11, 2005 5:54 PM