President a nd C hief E xecutive O fficer
Candidate S ummary S heet
Current Title,
Title (Dr.,
First
Last Name
Institution,
Phone#
Home Address
Email
Mr., Ms.)
Name
State
Home:
Work:
Cell:
Personal:
Office:
Highest D egree:
Year:
Institution:
Field:
Current T itle/Position:
Institution o r O rganization:
Years i n P osition:
City a nd S tate:
Accomplishments ( top f our)
nd
2
t o L ast T itle/Position:
Institution o r O rganization:
Years i n P osition:
City a nd S tate:
Accomplishments ( top f our)
rd
3
t o L ast T itle/Position:
Institution o r O rganization:
Years i n P osition:
City a nd S tate:
Accomplishments ( top f our)
Applicant t o a ttach m ost r ecent d escription o f c urrent o rganization o r i nstitution:
•
Applicant t o i nsert t he U RL a ddress f or y our l ocal n ewspaper
•
1101 17
Street, NW, Suite 300 • Washington, DC 20036 • 202.775.4667 • fax 202.223-1297•
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