Directory of Recipients Form

By submitting this form, you give CDIP permission to include the information you provide below in the Directory of Recipients.

The Directory of Recipients is distributed to the following CSU campus officials to be used as a recruitment tool: presidents, chief academic officers, EEO officers, deans/associate vice-presidents of faculty affairs, school deans and academic senate chairs, and CDIP coordinators.

The deadline for submitting the Directory of Recipients Form has passed.

* Required Fields


Enter the information that you would like printed in the Directory
* First Name
 
* Last Name
Contact Information
Home Phone
* Current Email Address

CSU Faculty Mentor Information
Faculty Name
 
Faculty Department
 
Faculty Campus
 
Program Information
Doctoral Institution
 
Discipline
 
Specialization
 
Expected Year of Degree
 
Year of Degree
 
Post-Doc Information
Post Doc Institution
 
Post Doc Appointment Date
 
Scholarly Research
Research Topic
 
Research Description
 
Research Accomplishments
 
Research Awards