Name: _____________________________________ Social Security Number: _________________
E-mail address: ____________________________
Office Phone: ________________________ Home Phone: __________________________
Highest Academic Degree: ______________ Institution: _______________Year: ______
Institution where you received your undergraduate degree: _______________________
Research interests: _____________________________________________________________
Current employer and address: ____________________________________________________
____________________________________________________________________
_____________________________________________________________________
Number of years at the given institution: ______
Previous Employer:_______________________________________________________________
Describe courses you have taught or are currently teaching:
Approximate cost for travel to and from the meeting? ____________________________
Double room: Yes ____ No ____ If yes, Room mate: ________________________________
May we assign a companion from the other applicants? Yes _________ No ___________
Single room: I understand that I will be responsible for half the cost Yes ______
Send this application form, a statement of your teaching philosophy,
and a current curriculum vitae
to Dr. Montie Monzingo, Department of Mathematics, Southern Methodist University, Dallas, Texas 75275-0156
Phone: (214) 768-2677, Fax: (214) 768-2355, Email: mmonzing@mail.smu.edu
Document last modified 4/5/04.