RIT Future Faculty Career Exploration Program Application Name

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RIT Future Faculty Career Exploration

Program Application

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:

( ) Yes

( ) No

( ) Yes

Disabled Individual

( ) 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 [email protected]

.

4/14 RIT Future Faculty Career Exploration Program Application Page 2

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