UM School of Medicine Graduate Alumni Survey

The fields marked with a * are mandatory. Longer text fields can be copied and pasted from your word processor.

Personal Information:

* First Name

M.I.

* Last Name

Suffix

* Address

* City

* State

* Zip Code

* Country

* Home Phone

* Office Phone

Fax

Email Address

Personal/Lab Web Page URL

Graduate Training at UM

* Graduate Program

* Year Graduated

* Graduate Advisor 1

Graduate Advisor 2

Graduate Advisor 3

* Did you enter graduate school through the Interdisciplinary Biomedical Sciences (IBS) Program?

Yes

Post-Graduate Education & Training:

EDUCATION/TRAINING
(Include professional education, such as nursing, & postdoctoral training. For location include city, state/province, country. If not applicable, enter "none")

* Institution

Location

Degree

Year(s)

Field of Study

Positions & Honors:

* Positions and Employment
(e.g.1998-2002 Professor of Pediatrics, Harvard Medical School, Boston, MA)

Other Experience and Professional Memberships
(e.g. 1991-1997 NIH Study Section, IRG MDCN-9)

Honors
(e.g. 2001 Nobel Prize in Medicine or Physiology)

Research Interests:

* Does your current position include research activity?

Yes

(If you answered, no, then enter "none" for research interests.)

The type of research that you conduct is :

basic science research

clinical research

* Research Interest(s). A brief paragraph or series of keywords describing your research.

* Current Funded Research
(e.g. NIH/NEI RO1 EY12345, 1/99-1/04, project title. Enter "none" if not applicable.)

Publications

Please enter any peer-reviewed publications that you have authored or co-authored.
(Please use the following format: Brown J, Doe JB, Doe AC. Important research findings that should be reported. Science 2002;197:201-205.)

* Publications

Training Experience

If you have completed your training and have trained students, please indicate the number of people you have trained over the last 10 years in each of the following groups. Included current trainees in your count.

Undergraduates

Masters Students

Doctoral Students

Postdocs

Curriculum Vitae

Attach your CV to this form (NOTE: requires Internet Explorer4.0 or greater, Netscape 3.0 and greater, or AOL 4.0 and greater):

Please copy and paste your current CV into the text box below:

Thank You!

* Would you like to be added to our mailing list to be informed of events and announcements relevant to the University of Miami School of Medicine Graduate Programs?

Yes

Thank you very much for your time and please keep in touch! The following information is needed for delivery of your T-Shirt.

Shipping Address :

FORM: ALUMNI 081402 version 1

* Indicates Response Required