Institution (*): |
|
Department (*): |
|
Description:
(Optional text you wish to use to
describe your institution, or any other
comment. This is not saved to the
database but might be useful in
processing the form.) |
|
Head of the Department:
|
Title:
First Name (*):
Last Name (*):
Head's E-Mail (*): [Note: Department's general e-mail
has a separate field.]
|
Address:
(Enter three main lines for the
address, e.g., faculty/department and
the street address) |
|
City / State (if applicable): |
State: |
Post Box (if applicable): |
|
Postcode: |
|
Country (*): |
|
Telephone:
(include country code,
e.g. +1 for United States) |
|
Fax:
(include country code,
e.g. +1 for United States) |
|
Department E-mail (*): |
|
Web: |
|
Number of Academic
Teaching
and Research Staff: |
Full Time:
Part Time: |
Contact:
(Enter your name or the name
of the person
responsible for
maintaining information submitted
to Education Database.) |
Name: (*)
Contact e-mail (*):
|
Internet path for a logo:
(to be used in the Education Database
to identify your organization; max. width
and height 300 x 100 pixels) |
|