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									                                    UW LEND
                             Trainee Profile Worksheet



Please provide the following information about yourself. This information will by typed
onto your UW LEND Trainee Profile. Profiles for UW LEND long-term trainees are
posted on bulletin boards at CHDD and posted on the UW LEND website in the Trainee
Directory http://depts.washington.edu/lend/directory/trainees.html.
See UW LEND Consent Form; complete and sign this form to authorize permission for
posting your trainee profile.

Return the completed form to Nancy Saunders by email attachment:
charbert@u.washington.edu


Name:


E-Mail Address:


Hometown:


Discipline:


Faculty Mentor:


Training Period (beginning & end dates; month/year):


Schedule at CHDD (days of week you will be at CHDD):



Previous Degrees & Educational Institution OR Related Experience:



List two or three of your personal UW LEND training goals:

								
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