Application for Affiliate Status in Microbiology and Cell Science

First Name:
Last Name:
Office Phone
Lab Phone
Email Address

Briefly describe your reasons for requesting affiliation with the Microbiogy and Cell Science departments.

List the courses you teach or participate in.

Paricipation in the core curriculum is required. This consists of presenting at least two guest lectures within the the first 2 years of affiliate membership. Are you willing to fulfill this requirement?

On which graduate studies subcommittee(s) (recruiting, admissions, advising, or development) might you be interested in serving?

List the Ph.D. students you have trained in the past 5 years.
Name Degree Program Year Entered Current Status

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