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Form 428A
OMB No. 3145-0058  Exp. 10/31/2018

Thanks for your time and for indicating your willingness to serve as a reviewer. We cannot guarantee your place on an AAG panel, but we greatly appreciate your interest. Please also note that you must hold a PhD degree ﴾or equivalent﴿ to serve as a panelist.
First Name:

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* First Name:

Last Name:

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* Last Name:

Email Address:

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* Email Address:

Institution:

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* Institution:

When did you receive your PhD degree (or equivalent)?

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* When did you receive your PhD degree (or equivalent)?

Your geographical region (http://en.wikipedia.org/wiki/United_Nations_geoscheme)

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* Your geographical region (http://en.wikipedia.org/wiki/United_Nations_geoscheme)



You will have the option to add secondary and tertiary expertise and/or research techniques on the next screen(s).
Primary area of expertise:

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* Primary area of expertise:

Primary Research Area Technique:

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* Primary Research Area Technique:

Please provide a brief description of your research interests.

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* Please provide a brief description of your research interests.

Are you interested in serving for 2 or 3 years as a temporary Program Director at NSF (aka “rotator”) in the foreseeable future?

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* Are you interested in serving for 2 or 3 years as a temporary Program Director at NSF (aka “rotator”) in the foreseeable future?

T