ࡱ> "$ !}  bjbjΨ 4zʤfʤf%B B 8 *"*******${,1/:*:*O*%%%F*%*%%@''pjX'*e*0*`',/5/'/'t%:*:*#H*/B X : DUKE UNIVERSITY MEDICAL CENTER CURRICULUM VITAE for Permanent Record and the Appointments and Promotions Committee Date Prepared: Name: (complete with degrees) ___________________________________________________ Primary academic appointment: ___________________________________________________ School of Nursing Division: ___________________________________________________ Secondary academic appointment: (if any) __________________________________________ Present academic rank and title: ___________________________________________________ Date and rank of first ɫֱ Faculty appointment ____________________________________ Nursing Licensure: North Carolina License #: ____________________________________ Date of License (Month/Day/Year): ______________________________ Current specialty certification(s): (certification, certifying body, year of issue, expiration date) ________________________________________________________________________ Date of birth: _________________ Place: (include city/state/country) _____________________ Citizen of: _____________________________________________________________________ Visa status (if applicable): ______________________________________________________ Education: InstitutionDates (Year)Degree(s)Major/MinorHigh School(s)College(s)Graduate or Professional School(s)Other Scholarly societies (e.g. Sigma Theta Tau, Phi Beta Kappa, Sigma Xi, etc): SocietyDate (Year) Professional and academic career: InstitutionPosition/TitleDates (Year) Publications: 1. Refereed journals: Published1.2.3.4.In press1.2.Submitted or in review1. 2. Non-refereed publications: Published1.2.3.In press1.Submitted or in review1. 3. Chapters in books: Published1.2.3.In press1.Submitted or in review1. 4. Books: Published1.2.In-Press1.Submitted or in review1. 5. Non-authored publications: Published1.2.In press1.Submitted or in review1. 6. Other: a. Published expert panel reviews, consensus statements, practice guidelines, etc. 1.2.b. Published abstracts 1.2.c. Editorials, position, and background papers 1.2.d. Distributed / disseminated works in other media 1.2. Media Coverage (list by type) Presentations (not included in abstracts above) a. Invited Presentations PresentationDate1.2. b. Selected Other Presentations PresentationDate1.2. Consultant appointments: AppointmentDate(s) Professional awards and special recognitions: AwardDate(s) Professional organizations and participation: (offices held, committee assignments, etc.) Professional OrganizationOffice Held and/or Committee AssignmentDates Editorial boards: Review panels: Teaching responsibilities: Classroom and Online Teaching: Course NumberCourse NameDates: Semester/Year Continuing Education: LocationAudienceCourse Title Date(s) Graduate and Post-Doctoral Supervision: Post-Doctoral Fellows or Associates 1.2. PhD Dissertations 1.2. DNP Capstone Projects 1.2. Masters Theses / Research Projects 1.2. Areas of research interest (list): External support - gifts, grants, and contracts: Separate sections are provided for research support, educational/training support, and other external support. 1. Research Support Research: PresentCurrently Active Project Number: Status on Grant Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: Research: Pending Project Number: Status on Grant: Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: Research: Past Project Number: Status on Grant: Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: 2. Educational/Training Support Educational/Training: PresentCurrently Active Project Number: Status on Grant Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: Educational/Training: Pending Project Number: Status on Grant: Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: Educational/Training: Past Project Number: Status on Grant: Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: 3. Other External Support Other Support: PresentCurrently Active Project Number: Status on Grant Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: Other Support: Pending Project Number: Status on Grant: Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: Other Support: Past Project Number: Status on Grant: Approved Project Period: % Effort: PI: Source: Annual Direct Costs: Title of Project: Project Goal: Clinical activity Type of practice and estimate of time commitment: Participation in academic and administrative activities: Administrative activities and/or committee assignments at institutions previous to ɫֱ: (if applicable; provide a separate list for each institution) Institution: Activities and/or Committee AssignmentsDate(s) Administrative activities and/or committee assignments at ɫֱ: (School of Nursing, Medical Center, and University) ɫֱ: Activities and/or Committee AssignmentsDate(s) ɫֱ University Medical Center: Activities and/or Committee AssignmentsDate(s) ɫֱ University: Activities and/or Committee AssignmentsDate(s) __________________ _____________________________________________ Date Signature of Chair Personal Information Faculty members preferred familiar name: __________________________________________ Home address: ________________________________________ ________________________________________ Home Phone # ________________________________________     PAGE  PAGE 1  0126GOuv   - . 7 K L M W a  - . ^ _  Ŀܷh~>hG hb6h~>hg6hCh"hehg>*hb hbhbhghg6hthghGhg5H 126GOuv- . - . gdbgdg $7$8$H$a$gdg$a$gdg   ! 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