SCHOOL OF MEDICINE CV FORMAT
Revised May 2002

                                                                                                        Date of Preparation:
                                                                                                        _____________________________
                                                                                                        Signature

NAME

Office Address:                                                                                          Home Address:

Telephone:                                                                                                 Telephone:

PERSONAL DATA:

EDUCATION:
(Give name of institution, place, and date of degree in chronological order)

Baccalaureate:
Graduate:

TRAINING:
Postgraduate: (postdoctoral, internships & residencies, etc. in chronological order)

FACULTY APPOINTMENTS:

HOSPITAL OR OTHER PROFESSIONAL APPOINTMENTS:
(Limit to key appointments -- in chronological order -- such as Division Head, Surgeon General-HEW, Fulbright Scholar)

MAJOR PROFESSIONAL SOCIETIES:

LICENSURE AND BOARD CERTIFICATION:

HONORS/AWARDS:

SERVICE:

1. Patient care
2. Professional consultation (other than patient care)
   a. Public presentations as an expert in discipline
   b. Testimony before public bodies
   c. Consulting to public agencies, foundations, professional associations
   d. Consulting to private enterprises
3. Journal/Editorial activity
   a. Editorships
   b. Editorial board memberships
4. Other professionally related service
5. National and international boards and committees
   a. Positions held in professional associations
   b. Memberships/offices held in public agencies related to discipline
6. State and local boards and committees

CV FORMAT
Page Two

TEACHING:

1. Years at Wayne State
2. Years at other colleges/universities (please list)
3. Courses taught at Wayne State in last five years
   a. Undergraduate
   b. Graduate
   c. Graduate Professional
   d. Medical Students (Years I-IV)
   e. Residents/Fellows
4. Essays/Theses/Dissertations directed (list students by name, level, title of project, year)
5. Course or curriculum development
6. Course materials (unpublished)

GRANT SUPPORT:
(List in chronological order current and previous grant funding with comprehensive information such as agency, title, dollars awarded, period of award, PI, etc; include approved but not funded grant applications; appointments with tenure must include grant activity for the last ten years)

PUBLICATIONS:
(Separate into 6 basic categories; use standard format with inclusive page numbers for all publications, e.g., Doe, Jr., A.G., Smith, A.S., Wilde, E.F. A Rare Finding of a Fecolith in the Circle of Willis. J. Neurenterol. 22:172-76, 1974.)

1. Original observations in refereed journals
2. Review articles
3. Books and chapters
4. Case reports
5. Educational materials (including computer programs)
6. Patents

PUBLISHED ABSTRACTS: (optional but only for last five years)

PRESENTATIONS:

1. Invited and/or refereed international or national meetings
2. Invited and/or refereed local/regional meetings
3. Invited seminars or lectures presented in last five years
4. Other scholarly work