Prairie View A&M University
Whitlowe R. Green College of Education
Department of Curriculum and Instruction
Status Update of Graduates and Currently Enrolled Candidates
Directions: Please complete the information requested below. We will use this feedback to enhance our
customer service, assist with the recruitment and retention of our candidates and graduates, and address state
and national agency standards. Your information will not be distributed outside of the university without your
expressed permission. If you have questions, please contact us at
1.
Name (First, Middle, Last)
2. Enrollment Status
Enrollment Start Date
Semester
Year
❑ Current Graduate Student
❑ Current Undergraduate Student
Major Area
Degree
Minor Area
Anticipated Graduation Semester
Year
❑ Alumni - Graduation Semester
Year
I Master's Thesis Information (Master's Students and Graduates Only)
Thesis Title:
Committee Chair:
Committee Members:
4. Certification and Licensure
Type of Certification/License
Type of Certification/License
5. Current Mailing Address
oCurrently Held ❑ Pursuing/Applying
oCurrently Held ❑ Pursuing/Applying
Permanent Mailing Address
6. Personal Telephone Numbers
Home #:
Mobile #:
Home Fax #:
7. Preferred Email Address(es):
8. Current Position and Place of Employment Mailing Address
Employer:
Position:
Duties and Key Accomplishments:
Office Address (Building and Room #):
Created 06/27/13 for Implementation beginning Summer 2013
Mailing Address:
Office Fax #:
Office #:
9. Awards, Accomplishments, and Honors (2008-Present)
(If you have more items than space is provided, please add to the boxes with additional information
or duplicate the table below. If you have items that have already been accepted for a future month
of this year, please include those as well).
Type of
Accomplishment
Published Books
and Journal
Articles
Title:
Title:
Title:
Name of Journal or
Name of Journal or Agency:
Agency:
Name of Journal or
Agency:
Year:
Year:
Presentation Title:
Presentation Title:
Presentation Title:
Association/Organization:
Association/Organization:
Association/Organization:
Year:
Presentations
Date:
Grants and
Sponsored
Research
Awards and
Honors
Date:
Date:
Grant 1
Project Title:
Grant 1
Grant 1
Project Title:
Project Title:
Sponsoring Agency:
Sponsoring Agency:
Sponsoring Agency:
Amount Funded:
Amount Funded:
Amount Funded:
Year:
Year:
Year:
Award 1
Agency Giving Award:
Award 1
Agency Giving Award:
Award 1
Agency Giving Award:
Distinction:
Distinction:
Distinction:
Year:
Year:
Year:
Thank you for providing this important information!
Created 06/27/13 for Implementation beginning Summer 2013