Name :___________________________________________________________________
Address :_________________________________________________________________
City/State/Zip: ____________________________________________________________
Phone : _________________________ E-mail: __________________________________
Alt. Phone :_______________________ Alt.
E-mail: ______________________________
Phase of doctoral studies : ( )Ph.D. complete ( ) ABD <All But Dissertation> ( ) last year of Ph.D. coursework ( ) 5 th year ( ) 4 th year ( ) 3 rd year ( ) 2 nd year ( ) 1 st year ( )Other
Institution: _______________________________________________________________
Major/Discipline: ________________________________________________________________
Anticipated date of Ph.D.
: _______________ (or) Anticipated date of MFA :_________________
Current Research Projects/Dissertation Topic :
Academic Specialty /Interest Areas :
Teaching Experience: ( ) teaching assistant ( ) recitation ( ) lab assistant ( ) lecturer ( ) adjunct
Education: Degrees Obtained/ Pending
(List in order beginning with Least Current )
______________________________________
University Name
________________________________
______________________________________
______________________________________
________________________________
________________________________
Working on Post Doctoral Training ? ( ) Yes ( ) No
If yes, Where?
:__________________________ Area of Research :_____________________
Anticipated Date of Post-Doctoral completion:______________________________________
Interested in teaching? ( ) Yes ( ) No
Once you have completed your Ph.D. program what courses do you feel competent teaching?
What academic areas would you have interest in teaching/developing in the future?
What type of research might you pursue in the future?
4/14 RIT Future Faculty Career Exploration Program Application Page 1

Do you know of other Ph.D. candidates who may be interested in the Future Faculty Career
Exploration Program? If so, please provide their name, address, email and phone number.
Specify Scholar/Fellow type: (i.e. SREB, FORD, SLOAN, AGEP
How did you hear about u s?
RIT values diversity within its workforce and therefore would appreciate your completion of the information listed below. Your submission of this information is optional. This data is for analysis and affirmative action reporting only.
Please mark your responses :
Sex: ( ) M ( ) F
Race/Ethnic Group:
( ) White, Non-Hispanic [Europe, Middle East, North Africa]
( ) Black or African American [origin in black racial groups in Africa]
( ) Hispanic or Latino/a [Cuban, Mexican, PR, South or Central American or other Spanish cultures or origin regardless of race]
( ) American Indian/Alaskan [North, South, Central America; maintains tribal affiliation or community attachment ]
( ) Asian [ original peoples of Far East, SE Asia, Indian subcontinent ]
( ) Native Hawaiian or other Pacific Islander [original peoples of Hawaii, Guam, Samoa or other Pacific Islands]
Vietnam Veteran: Disabled Veteran: Disabled Individual :
( ) Yes
( ) No
( ) Yes ( ) Yes
( ) No ( ) No
RIT is in compliance with the Immigration Reform and Control Act of 1986.
Are you legally able to work in the U.S.? ( ) Yes ( ) No
Willing to relocate to Rochester? ( ) Yes ( ) No
______ ___________________________________________________________________________
Application Deadline: June 1, 2014
Please return your completed application, current curriculum vitae, and a cover letter including a statement of how you can contribute in meaningful ways to our diversity goals. MFA students only- please include an electronic sample portfolio of work. Send materials via fax, email, or mail to:
Rochester Institute of Technology
Office of Faculty Recruitment and Retention
111 Lomb Memorial Drive
Rochester, New York 14623
FAX: (585)475-4460
Questions? Please contact the office at 585-475-5775 or facultyr@rit.edu
.
4/14 RIT Future Faculty Career Exploration Program Application Page 2