Biodata for It Job

							                                                          FACULTY / PLANNERS / AUTHORS / PRESENTERS
   <ACTIVITY TITLE>                                                                                                                                         <ACTIVITY DATES>

                                these columns may be optional                                                         Forms Received?
Faculty/Author/Moderator    Rank Degree Job Title    Organization            Email          * Biodata       **             Disclose   Commerc If yes,     off-    $ Honorarium
Name Last       First                                                                       Form Rec'd      Present'n      Form       ial       resolved? label   Amount (note if
                                                                                            (or description Wksht (or      signed?    relations           use?    exceeds USU
                                                                                            of expertise &    objectives              hip ?                       limit)
                                                                                            qualifications)   & content
                                                                                                              outline)
Bricee           Jake                                NIH             jbricee@usuhs.mil                        √                                             no     $         200
DeKarr           Sheila                              EPA                                                                              no                          0
                                                     The National                                                                                                 500 + travel &
Double           Trouble                             Academies                              √                              √          no                          perdiem




                                                                                                                   Forms Received?
Planning Committee Name     Rank Degree Job Title    Organization            Email          * Biodata                      Disclose   Commerc If yes,             Honorarium?
Last           First                                                                        Form Rec'd                     Form       ial       resolved?         Amount$
                                                                                            (or description                signed?    relations
                                                                                            of expertise &                            hip ?
                                                                                            qualifications)




                                         Key:
Yes =            √ or Y     * Biodata form may be omitted if the required information is provided on the 6 column outline.
No =             N or -0-   ** Presentation Wksht may be omitted if the objectives and content outline are provided on the 6 Column Form
                                                                                                                                                                  20-Oct-08
                                                                                                                                                                  11-Aug-09
                                                  D:\Docstoc\Working\pdf\a74192a1-8b89-42eb-bc8b-8f4bedf12607.xls