Form 100
Name, PIN
[Maximum of 5 pages for all content below.]
1. Most Significant Contributions to Research and/or to Practical Applications [List up to five—
remember, a contribution does not have to be a single publication, but can be a group of publications on
a specific subject. Suggest devoting 1-2 pages to this section. This is also the place to list publications,
patents, etc., that fall outside the six-year maximum, but for which the impact is being felt now. For
each, describe the significance in terms of influence on the direction of thought and activity in the target
community and in terms of significance to, and use by, other researchers and end users.]
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2. Research Contributions and Practical Applications over the last six years (2003-2009) [Do not
repeat contributions listed in section 1. Bold names of student co-authors and list the source of funding
for each contribution, using parentheses to indicate the primary source of funding for each contribution.]
2.1 Articles in refereed publications
Published or Accepted
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Submitted
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2.2 Other refereed contributions [e.g. letters, notes, communications; review articles; papers in
refereed conference proceedings]
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2.3 Non-refereed contributions [e.g. papers in conference proceedings; review articles; technical
reports, internal reports; monographs, books or book chapters; conference presentations.]
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2.4 Contributions to practical applications of knowledge [e.g. R&D activities; technology or product
development; technology transfer and commercialization; patents and copyrights.]
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3. Other Evidence of Impact and Contributions [e.g. awards, prestigious invited lectures; journal
editorships; consulting activities]
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4. Delays in Research Activity [Only use this section if truly needed and delays are well justified.]
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5. Contributions to the Training of Highly Qualified Personnel (HQP)
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