NCAS-M Alumni Form NCAS-M Alumni Form "*" indicates required fields Step 1 of 5 20% Date Submitted* MM slash DD slash YYYY Background InformationName* First Last Email* Phone*What is the best way to contact you?* Phone Email University/ies Attended (as an NCAS/NCAS-M Fellow)*To select multiple items in a list, hold down the Ctrl (PC) or Command (Mac) key. Then click on your desired selections.Fort Valley State UniversityHoward UniversityJackson State UniversityPennsylvania State UniversitySan Diego State UniversitySan Jose State UniversityTuskegee UniversityUniversidad MetropolitanaUniversity of Albany State University of NYUniversity of Maryland Baltimore CountyUniversity of Maryland College ParkUniversity of Puerto Rico MayaguezUniversity of Texas El PasoStarting Year with NCAS/NCAS-M*Please enter a number greater than or equal to 2000.Ending Year with NCAS/NCAS-M*Please enter a number less than or equal to 2022.NCAS/NCAS-M Cohort(s)* NCAS NCAS-M Cohort 1 NCAS-M Cohort 2 NCAS-M Cohort 3 NCAS-M Cohort 4 NCAS-M Cohort 5 Experiential Training Summer Program (ETSP) NCAS-M Faculty Advisor*Select faculty advisorTerri Adams, PhDJuan Arratia, PhDRoy Armstrong, PhDSen Chiao, PhDBelay Demoz, PhDYasmín Detrés, PhDSonya Smith, PhDGamal El Afandi, PhDJoseph Essamuah-Quansah, PhDMehri Fadavi, PhDSouleymane Fall, PhDRosa M. Fitzgerald, PhDJose D Fuentes, PhDThomas E. Gill, PhDCharles Ichoku, PhDEverette Joseph, PhDRicardo Kendi Sakai, PhDHaydar Kurban, PhDSiwei Li, PhDXin-Zhong Liang, PhDDuanjun Lu, PhDCeleste Malone, PhDQilong Min, PhDVernon R. Morris, PhDRemata S. Reddy, PhDSamuel Shen, PhDHari P. Singh, PhDWilliam Stockwell, PhDCarolyn Stroman, PhDTia C. M. Tyree, PhDLoren D. White, PhDOtherDegree Level Pusued*Please select the degree level pursued while engaged with NCAS-M. BS BA MS MA PhD None Other HiddenHighest Degree Level Achieved* BS/BA MS/MA PhD None Major*Please enter the major(s) that you pursued while engaged with NCAS-M. HiddenMajorPlease enter the major that you pursued for the aforementioned degree, if different from the major pursued while engaged with NCAS-M. Did you complete the degree that you were pursuing while engaged with NCAS-M* Yes No HiddenGraduation Date* Month Day Year Please provide additional details if you did not complete the degree that you were pursuing while engaged with NCAS-M.Please upload an updated picture/headshotAccepted file types: jpg, jpeg, png, gif. Thesis DetailThesis/Dissertation/Project Title*Please enter the title to the thesis/dissertation/project completed while engaged with NCAS-M. If not applicable, enter N/A. If applicable, please share a URL link to your thesis/dissertation/project completed while engaged with NCAS-M. If applicable, please upload your thesis/dissertation/project.Max. file size: 128 MB.If applicable, please upload your thesis/dissertation/project data.Max. file size: 128 MB. Current EmploymentCurrent Employer*Please enter employer name. If not applicable, enter N/A. Current Position*If not applicable, enter N/A. Current Employment Location*If not applicable, enter N/A. City State / Province / Region Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Start DatePlease provide approximate start date for your current employer. Month Day Year Continued EducationAs applicable, please provide detail on your continued education.Current Academic Institution*Please enter institution name (for continuing students). If not applicable, enter N/A. Current Academic Institution Location*If not applicable, enter N/A. City State / Province / Region Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Current Degree Level Pursued*Please select the degree level that you are currently pursuing. Not applicable BS BA MS MA PhD Other Major*Please enter the major that you are currently pursuing. If not applicable, enter N/A. Program Start Date*Please enter the approximate date that you started the program/degree that you are currently pursuing. Month Day Year Social Media DetailTwitter handle Instagram handle PhoneThis field is for validation purposes and should be left unchanged.
