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REGISTRATION FORM: FACULTY AFFILIATES
Your Name: ___________________________ Date of Birth: __ __ ____
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Do you feel you will increase your value through active Affiliation? Yes __ No___
Name of your University/School?
Do you do Research? Yes __ No___
Interested in Potential Applied Research Topics/Projects?
Yes __ No__
Interested in Consultation outside Academic Responsibilities? Yes__No What Skills:
Hourly Rate Range:
Would you mentor undergraduate or graduate students we help place in internships? Yes __ No__
Please send your resume via email.
Please list three professional references with full
Contact 1:(name, address, phone, email)
Contact 2:(name, address, phone, email)
Contact 3:(name, address, phone, email)
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What will you bring to the National Architect which is unqiue?
What issues do you find most challenging, and really want to solve?
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