From:, Head, Department of 

To:   D.N. Wormley, Dean (w/attach.)
        A. A. Atchley, Associate Dean, Research & Administration (w/attach.)
        R. S. Engel, Associate Dean, Academic Programs (w/attach)

Date/Time of Interviews: DeanAssoc. Deans

Name of Candidate:

Ph.D. Institution:Major:

Research Area:

Current Position and Location:

Citizenship Status: U.S. Perm. Visa Other: (Specify)

Affirmative Action: Woman Black Am. Indian Hispanic

Viet Nam Vet. Other

Anticipated Faculty Rank:

Tenure Status:

New Position: Yes No

Name of Previous Occupant of this Position (if any)

Name of Other Candidates being Interviewed for this Position:

Attachments:
Copy of Affirmative Action Advertisement Candidate's Resume Candidate's Interview Itinerary

Letters of Reference and/or Record of Telephone Interviews