form

Lulu Delacre

To submit your proposal online please fill the form below:

NAME:
E-MAIL:
SOCIAL SECURITY NUMBER:
MAJOR FIELD OF SPECIALIZATION:
CURRENT POSITION AND UNIVERSITY AFFILIATION:
OFFICE ADDRESS:
OFFICE TELEPHONE NUMBER:
HOME ADDRESS:
HOME TELEPHONE:
HIGHEST DEGREE RECEIVED:
FIELD:
DATE OF RECEIPT:
INSTITUTION:
LANGUAGE ABILITY (rate per scale):	1 = No practical usable proficiency 2 = Ability to read simple prose with difficulty, follow simple conversation, use the language to get around, but not as a means of exchanging ideas. 3 = Ability to read non-technical materials and technical writing in one's field, o understand ordinary native speech, to carry on an exchange of ideas, though haltingly. 4 = Fluency, accuracy, and range adequate for all normal professional and social situations. 5 = Fluency, accuracy, and range of an educated native use of the language.
SPANISH:	1 2 3 4 5
PORTUGUESE:	1 2 3 4 5
ENGLISH:	1 2 3 4 5
OTHER (specify):	1 2 3 4 5
TIME PERIOD DURING WHICH YOU EXPECT TO CONDUCT YOUR RESEARCH (Between May 1 and August 14):
RESEARCH TO BE CONDUCTED AT THE UNIVERSITY OF PITTSBURGH:
SUMMARIZE YOUR POTENTIAL LECTURE OR OTHER ACTIVITY:
Please Remember to send you CV, Proposal and Budget in microsoft word Document format to:	bravo@pitt.edu