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EDUCATIONAL RECORD
(GIVE NAME AND LOCATION OF SCHOOLS)

SECONDARY SCHOOL

DATE OF ATTENDANCE

COLLEGE OR UNIVERSITY

DATE OF ATTENDANCE

MAJOR SUBJECT

DEGREE RECEIVED - - DATE

NAMES OF OTHER TECHNICAL SCHOOLS OR COLLEGES

ADDITIONAL DEGREES RECEIVED - - BY WHOM CONFERRED - - DATE

PROFESSIONAL RECORD
In the space below supply a brief and concise resumé of your engineering work ending with your present position. Designate each engagement or change in position by the use of a separate line, listing starting and terminating dates in the left-hand column. For each entry give:
(1) Name and address of employer.
(2) Your title or position, avoiding unqualified use of the terms "Aeronautical Engineer" and "Consulting Engineer".
(3) An outline of your work including duties, degree of responsibility, and extent to which you are responsible for the work of others.

If space available is inadequate, supplementary sheet of this size may be attached.

(PLEASE FILL IN BY HAND LETTERING OR TYPEWRITER)
[Box below to fill out with the right section smaller than the left which is left blank for the user to write in]
From
To

REFERENCES
List four references who are familiar with your aeronautical activities. Signatures are not required; addresses of non-members must be supplied. Two of the references listed must be members of the Institute; designated grades next to their names if known. If possibles, name at least one more than the required number of references.
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