Arizona State University
Scholar Profile
Request Form
Purpose
The Graduate Support Programs office publishes profiles of outstanding scholars at ASU; as well as highlights outstanding research and accomplishments on the website, social media, in printed materials and/or news releases.
Procedure
Please complete sections of this form that pertain to you and send it along with a photo of yourself to gradinfo@asu.edu. The photo needs to be sharp and clear, preferably taken at medium to high quality with a digital camera. Head shots are preferred and it should be of you alone with no other people in the photo. If you would prefer to have your photo taken by a Graduate Education staff member, please contact gradinfo@asu.edu to make arrangements. Prior to posting or publishing any of your information we will contact you to review your profile for accuracy.
|Part I: To be Completed by All |
|LAST NAME |FIRST NAME |MIDDLE NAME |
| | | |
|ASU AFFILIATE ID# |email |Phone |
| | | |
|COLLEGE |PROGRAM |DEGREE |
| | |Master’s PhD |
|I am affiliated with (check as many as apply): |
| ASU IGERT Program (enter name of IGERT program) |
| ASU Postdoctoral Scholar |
| Graduate Education Fellowship (enter name of fellowship) |
| Graduate Education Professional Development Programs (enter program name) |
| Shades Multicultural Mentoring Program |
| Other |
|Please give a brief synopsis of your research/studies: |
|Name one or two ways in which you hope that your research will positively impact society: |
|Why did you decide to earn your graduate degree at ASU? |
| |
|Part II: To be Completed by Current ASU Students |
|What is your career goal? |
| |
|Projected Graduation Date |Title of Thesis or Dissertation |
| | |
|Publications, Honors, Recognitions or Awards |
| |
| |
|Part III: To be Completed by ASU Alumni and Postdocs |
|DEGREE |Year |Title of Thesis or Dissertation |University |
| | | | |
|DEGREE |Year |Title of Thesis or Dissertation |University |
| | | | |
|Publications, Honors, Recognitions or Awards |
| |
|Current Place of Employment |city |state |
| | | |
|Job Title |
| |
|Part IV: Model and Information Release |
|I grant permission to the Arizona Board of Regents, on behalf of Arizona State University and its agents or employees, to copyright and publish all or any part |
|of photographs and/or motion pictures and/or voice recordings and/or written/spoken statements taken of me for use in university publications, including |
|printed, moving, audio and electronic, all exhibitions, public displays, publications, commercial art, and advertising purposes in any media without limitation |
|or reservation. I hereby waive any right to inspect or approve the finished photographs/motion pictures/voice recordings/ written/spoken statements or printed |
|or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to |
|royalties or other compensation arising from or related to the use of the photographs/motion pictures/voice recordings/ written/spoken statements. |
|I hereby agree to release, defend, and hold harmless the Arizona Board of Regents, on behalf of Arizona State University and its agents or employees, including |
|any firm publishing and/or distributing the finished product in whole or in part, whether on paper, in motion pictures, or via electronic media, from and |
|against any claims, damages or liability arising from or related to the use of the photographs/motion pictures/voice recordings/written/ spoken statements, |
|including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that |
|may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution. It is the discretion of |
|Arizona State University to decide whether to use the image. |
|I agree that any photographs taken by me and submitted by me to the Graduate Education office will not be copyrighted by ASU, but ASU will retain all usage |
|rights as listed above. |
|I am 18 years of age or older, and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the |
|contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions|
|in writing before signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release. |
|By typing my name below (or inserting my electronic signature), I verify that I have read and agree to the terms outlined in |
|Section IV. |
|Signature: |DATE: |
Submit this form and photo or to ask questions:
|Email: |Save this file with your name as the |Fax: |480-965-0375 |Walk: |Graduate Support Programs |Call: |480-727-7627 |
| |file name and send as an attachment | | | |Interdisciplinary Building B Suite | | |
| |to gradinfo@asu.edu | | | |285 | | |
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