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 | | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download