University of Illinois at Rockford - College of Medicine

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Rockford » Faculty Information Form

Faculty Information Form

Faculty Information Form

Web Site Faculty Update

In order to create the department faculty pages for the College of Medicine at Rockford Web site, it is asked that all faculty members complete the following form to update personal information. Please do not send CVs. If you have any questions, contact prrockford@uic.edu.


Faculty Name (w/ certifications):

Would you like your picture on the Web site?: Yes No

Department(s)/Clinic(s):



Faculty Appointment:

Additional Title(s):


Clinical Interests:

Research Interests:


Undergraduate Degree:

Graduate Degree:

Medical Degree:

Residency:

Fellowship:

Awards ans Special Recognition:

Professional Memberships:


Academic Office Address:

Academic Office Telephone:

E-mail:

Would you like your E-mail address published on the Web site? Yes  No