**U.S. DEPARTMENT OF ENERGY**

**FUSION ENERGY SCIENCES**

**GRADUATE FELLOWSHIP PROGRAM**

**FUSION SCIENCE COMPONENT**

**UNIVERSITY PARTICIPATION APPLICATION**

**Cover Page**

<table>
<colgroup>
<col style="width: 18%" />
<col style="width: 8%" />
<col style="width: 1%" />
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 14%" />
<col style="width: 12%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 32%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Institution</td>
<td colspan="9">     </td>
</tr>
<tr class="even">
<td colspan="3">Department(s)/Program</td>
<td colspan="7">     </td>
</tr>
<tr class="odd">
<td colspan="5">City      </td>
<td colspan="4">State      </td>
<td>Zip      </td>
</tr>
<tr class="even">
<td colspan="10">Fellowship Coordinator Designee:</td>
</tr>
<tr class="odd">
<td colspan="6">Name      </td>
<td colspan="4">Title      </td>
</tr>
<tr class="even">
<td colspan="6">Telephone Office:      </td>
<td colspan="4">Department      </td>
</tr>
<tr class="odd">
<td colspan="6">Telefax Number      </td>
<td colspan="4">Email Address      </td>
</tr>
<tr class="even">
<td colspan="10">Internet Address      </td>
</tr>
<tr class="odd">
<td colspan="2">Mailing Address</td>
<td colspan="8">     </td>
</tr>
<tr class="even">
<td colspan="4">City      </td>
<td colspan="4">State      </td>
<td colspan="2">Zip      </td>
</tr>
<tr class="odd">
<td colspan="10">To be signed by an academic official with authority to
make university commitments</td>
</tr>
<tr class="even">
<td colspan="7">Signature</td>
<td colspan="3">Date <u>     </u></td>
</tr>
<tr class="odd">
<td colspan="10">Full Name (typed)      </td>
</tr>
<tr class="even">
<td colspan="5">Mailing Address</td>
<td colspan="5">     </td>
</tr>
<tr class="odd">
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="10"><p>Original Application and six copies (with
appendices) must be submitted</p>
<p>no later than January 31, 2007 (complete application not to exceed 25
pages)</p></td>
</tr>
<tr class="odd">
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="10"><strong>ALL FORMS MAY BE REPRODUCED AS
NEEDED.</strong></td>
</tr>
<tr class="odd">
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="10"><p>Return completed application to:</p>
<p>Fusion Energy Sciences Graduate Fellowship Program</p>
<p>Science and Energy Engineering</p>
<p>Oak Ridge Institute for Science and Education</p>
<p>P.O. Box 117, MS 36</p>
<p>Oak Ridge, TN 37831-0117</p>
<p>Telephone: (865) 576-2194</p></td>
</tr>
</tbody>
</table>

FUSION ENERGY SCIENCES

GRADUATE FELLOWSHIP

UNIVERSITY APPLICATION CHECKLIST

> Cover Page
>
> Checklist
>
> Capabilities and Commitments
>
> *Course Offerings (Table Aa & Ab)*
>
> Core Curriculum (Table Aa)
>
> Course Offerings (Table Ab)
>
> Titles of Projects, Theses and Dissertations in the Fusion Energy
> Sciences Area (Table B)
>
> Postgraduate Employment (Table C)
>
> Faculty Listing (Table D)
>
> Faculty Vitae (Table E)
>
> Research Projects (Table F)
>
> *Facilities and Equipment (Tables Ga & Gb)*
>
> Research Table (Ga)
>
> Instructional Table (Gb)
>
> Additional Materials (Table H)

  ---------------- -------------------------------------------------------------
  Institution      [     ]{.underline}

  **CAPABILITIES   
  AND COMMITMENTS  
  OF THE           
  UNIVERSITY TO    
  THE TECHNICAL    
  AREA(S)**        

                   
  ---------------- -------------------------------------------------------------

+---------+------------------------------------------------------------+
| Inst    | [     ]{.underline}                                        |
| itution |                                                            |
+---------+------------------------------------------------------------+
| **Table |                                                            |
| Aa**    |                                                            |
|         |                                                            |
| *       |                                                            |
| *COURSE |                                                            |
| CURRI   |                                                            |
| CULUM** |                                                            |
+---------+------------------------------------------------------------+
| Please  |                                                            |
| list    |                                                            |
| the     |                                                            |
| core    |                                                            |
| cur     |                                                            |
| riculum |                                                            |
| for the |                                                            |
| fusion  |                                                            |
| science |                                                            |
| program |                                                            |
| at your |                                                            |
| school, |                                                            |
| broken  |                                                            |
| down by |                                                            |
| year    |                                                            |
| and by  |                                                            |
| term    |                                                            |
| (if     |                                                            |
| appli   |                                                            |
| cable). |                                                            |
| All     |                                                            |
| core    |                                                            |
| courses |                                                            |
| and     |                                                            |
| el      |                                                            |
| ectives |                                                            |
| should  |                                                            |
| be      |                                                            |
| i       |                                                            |
| ncluded |                                                            |
| in      |                                                            |
| Table   |                                                            |
| Ab of   |                                                            |
| this    |                                                            |
| appli   |                                                            |
| cation. |                                                            |
| The     |                                                            |
| listed  |                                                            |
| cur     |                                                            |
| riculum |                                                            |
| should  |                                                            |
| be the  |                                                            |
| one     |                                                            |
| that    |                                                            |
| app     |                                                            |
| ointees |                                                            |
| to the  |                                                            |
| Fusion  |                                                            |
| Energy  |                                                            |
| S       |                                                            |
| ciences |                                                            |
| Fel     |                                                            |
| lowship |                                                            |
| program |                                                            |
| will    |                                                            |
| follow  |                                                            |
| during  |                                                            |
| their   |                                                            |
| fel     |                                                            |
| lowship |                                                            |
| appoi   |                                                            |
| ntment. |                                                            |
+---------+------------------------------------------------------------+
|         |                                                            |
+---------+------------------------------------------------------------+

<table>
<colgroup>
<col style="width: 10%" />
<col style="width: 11%" />
<col style="width: 8%" />
<col style="width: 9%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 9%" />
<col style="width: 9%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Institution</td>
<td colspan="9"><u>     </u></td>
</tr>
<tr class="even">
<td colspan="10"><p><strong>TABLE Ab</strong></p>
<p><strong>COURSE OFFERINGS RELATED TO FUSION ENERGY
SCIENCES</strong></p>
<p><strong>(past five years)</strong></p></td>
</tr>
<tr class="odd">
<td colspan="5"><p>GRADUATE COURSES (check one)</p>
<p> Semester Hours</p>
<p> Quarter Hours</p></td>
<td colspan="5">Course Enrollment for Past Five Years</td>
</tr>
<tr class="even">
<td colspan="2">Course Number, Title and Catalog Description</td>
<td>Course Hours</td>
<td>Required/Elective</td>
<td>Frequency of Offering</td>
<td><p>This Year</p>
<p>20     </p></td>
<td><p>Last Year</p>
<p>20     </p></td>
<td><p>2 Years Ago</p>
<p>20     </p></td>
<td><p>3 Years Ago</p>
<p>20     </p></td>
<td><p>4 Years</p>
<p>Ago</p>
<p>20     </p></td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="odd">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
<tr class="even">
<td colspan="2">     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
<td>     </td>
</tr>
</tbody>
</table>

+-------+--------------+-----------------------+-----------------------+
| I     | [     ]      |                       |                       |
| nstit | {.underline} |                       |                       |
| ution |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
| **    |              |                       |                       |
| TABLE |              |                       |                       |
| B**   |              |                       |                       |
|       |              |                       |                       |
| **T   |              |                       |                       |
| ITLES |              |                       |                       |
| OF    |              |                       |                       |
| PROJ  |              |                       |                       |
| ECTS, |              |                       |                       |
| T     |              |                       |                       |
| HESES |              |                       |                       |
| AND   |              |                       |                       |
| DIS   |              |                       |                       |
| SERTA |              |                       |                       |
| TIONS |              |                       |                       |
| IN    |              |                       |                       |
| F     |              |                       |                       |
| USION |              |                       |                       |
| E     |              |                       |                       |
| NERGY |              |                       |                       |
| SCIEN |              |                       |                       |
| CES** |              |                       |                       |
|       |              |                       |                       |
| **    |              |                       |                       |
| (past |              |                       |                       |
| five  |              |                       |                       |
| ye    |              |                       |                       |
| ars - |              |                       |                       |
| you   |              |                       |                       |
| may   |              |                       |                       |
| limit |              |                       |                       |
| to 4  |              |                       |                       |
| for   |              |                       |                       |
| each  |              |                       |                       |
| c     |              |                       |                       |
| atego |              |                       |                       |
| ry)** |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
| **[   |              |                       |                       |
| Maste |              |                       |                       |
| rs]{. |              |                       |                       |
| under |              |                       |                       |
| line} |              |                       |                       |
| (list |              |                       |                       |
| gr    |              |                       |                       |
| anted |              |                       |                       |
| degre |              |                       |                       |
| es)** |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
| [St   |              | [Faculty              | [Title]{.underline}   |
| udent |              | Advisor]{.underline}  |                       |
| Na    |              |                       |                       |
| me]{. |              |                       |                       |
| under |              |                       |                       |
| line} |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
| *     |              |                       |                       |
| *[Doc |              |                       |                       |
| toral |              |                       |                       |
| (list |              |                       |                       |
| gr    |              |                       |                       |
| anted |              |                       |                       |
| deg   |              |                       |                       |
| rees) |              |                       |                       |
| ]{.un |              |                       |                       |
| derli |              |                       |                       |
| ne}** |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
| [St   |              | [Faculty              | [Title]{.underline}   |
| udent |              | Advisor]{.underline}  |                       |
| Na    |              |                       |                       |
| me]{. |              |                       |                       |
| under |              |                       |                       |
| line} |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+

+--------+----+-----------+------------+--------------+--------------+
| Insti  | [  |           |            |              |              |
| tution |    |           |            |              |              |
|        |    |           |            |              |              |
|        |  ] |           |            |              |              |
|        | {. |           |            |              |              |
|        | un |           |            |              |              |
|        | de |           |            |              |              |
|        | rl |           |            |              |              |
|        | in |           |            |              |              |
|        | e} |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
| *      |    |           |            |              |              |
| *TABLE |    |           |            |              |              |
| C**    |    |           |            |              |              |
|        |    |           |            |              |              |
| **     |    |           |            |              |              |
| POSTGR |    |           |            |              |              |
| ADUATE |    |           |            |              |              |
| EMPL   |    |           |            |              |              |
| OYMENT |    |           |            |              |              |
| OF     |    |           |            |              |              |
| GR     |    |           |            |              |              |
| ADUATE |    |           |            |              |              |
| FUSION |    |           |            |              |              |
| ENERGY |    |           |            |              |              |
| SCIE   |    |           |            |              |              |
| NCES** |    |           |            |              |              |
|        |    |           |            |              |              |
| *      |    |           |            |              |              |
| *(past |    |           |            |              |              |
| five   |    |           |            |              |              |
| y      |    |           |            |              |              |
| ears - |    |           |            |              |              |
| you    |    |           |            |              |              |
| may    |    |           |            |              |              |
| limit  |    |           |            |              |              |
| to 10  |    |           |            |              |              |
| in     |    |           |            |              |              |
| dividu |    |           |            |              |              |
| als)** |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
| S      |    | Deg       | Year of    | Post         | Employment   |
| tudent |    | ree-level | Graduation | graduation   |              |
| Name   |    |           |            | Employer     | Major        |
|        |    |           |            |              | Assignment   |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+
|        |    |           |            |              |              |
+--------+----+-----------+------------+--------------+--------------+

+-------+--------------+-----------------------+-----------------------+
| I     | [     ]      |                       |                       |
| nstit | {.underline} |                       |                       |
| ution |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
| **    |              |                       |                       |
| TABLE |              |                       |                       |
| D**   |              |                       |                       |
|       |              |                       |                       |
| **LI  |              |                       |                       |
| STING |              |                       |                       |
| OF    |              |                       |                       |
| FA    |              |                       |                       |
| CULTY |              |                       |                       |
| INV   |              |                       |                       |
| OLVED |              |                       |                       |
| IN    |              |                       |                       |
| F     |              |                       |                       |
| USION |              |                       |                       |
| E     |              |                       |                       |
| NERGY |              |                       |                       |
| SCIEN |              |                       |                       |
| CES** |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
| Rank  |              | Department            | Full-Time Equivalent  |
| and   |              |                       | Percentage of         |
| Name  |              |                       | Instruction and       |
|       |              |                       | Research Related to   |
|       |              |                       | Fusion Energy         |
|       |              |                       | Sciences              |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+
|       |              |                       |                       |
+-------+--------------+-----------------------+-----------------------+

+-------+----+------+-------+-----------------------------------------+
| I     | [  |      |       |                                         |
| nstit |    |      |       |                                         |
| ution |    |      |       |                                         |
|       |  ] |      |       |                                         |
|       | {. |      |       |                                         |
|       | un |      |       |                                         |
|       | de |      |       |                                         |
|       | rl |      |       |                                         |
|       | in |      |       |                                         |
|       | e} |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| **    |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| E**   |    |      |       |                                         |
|       |    |      |       |                                         |
| **FA  |    |      |       |                                         |
| CULTY |    |      |       |                                         |
| VITAE |    |      |       |                                         |
| FOR   |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| D     |    |      |       |                                         |
| LIST  |    |      |       |                                         |
| ING** |    |      |       |                                         |
|       |    |      |       |                                         |
| *     |    |      |       |                                         |
| *(Com |    |      |       |                                         |
| plete |    |      |       |                                         |
| this  |    |      |       |                                         |
| form  |    |      |       |                                         |
| or    |    |      |       |                                         |
| pr    |    |      |       |                                         |
| ovide |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| v     |    |      |       |                                         |
| itae. |    |      |       |                                         |
| P     |    |      |       |                                         |
| lease |    |      |       |                                         |
| limit |    |      |       |                                         |
| to    |    |      |       |                                         |
| one   |    |      |       |                                         |
| page  |    |      |       |                                         |
| per   |    |      |       |                                         |
| perso |    |      |       |                                         |
| n.)** |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| For   |    |      |       |                                         |
| all   |    |      |       |                                         |
| cu    |    |      |       |                                         |
| rrent |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| comm  |    |      |       |                                         |
| itted |    |      |       |                                         |
| to    |    |      |       |                                         |
| F     |    |      |       |                                         |
| usion |    |      |       |                                         |
| E     |    |      |       |                                         |
| nergy |    |      |       |                                         |
| Sci   |    |      |       |                                         |
| ences |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Name: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Aca   |    |      |       |                                         |
| demic |    |      |       |                                         |
| Rank: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Date  |    |      |       |                                         |
| of    |    |      |       |                                         |
| In    |    |      |       |                                         |
| itial |    |      |       |                                         |
| Ap    |    |      |       |                                         |
| point |    |      |       |                                         |
| ment: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| De    |    |      |       |                                         |
| grees |    |      |       |                                         |
| (     |    |      |       |                                         |
| where |    |      |       |                                         |
| and   |    |      |       |                                         |
| when  |    |      |       |                                         |
| c     |    |      |       |                                         |
| onfer |    |      |       |                                         |
| red): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Field |    |      |       |                                         |
| of    |    |      |       |                                         |
| Spec  |    |      |       |                                         |
| ializ |    |      |       |                                         |
| ation |    |      |       |                                         |
| and   |    |      |       |                                         |
| Areas |    |      |       |                                         |
| of    |    |      |       |                                         |
| Inte  |    |      |       |                                         |
| rest: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| S     |    |      |       |                                         |
| ignif |    |      |       |                                         |
| icant |    |      |       |                                         |
| Res   |    |      |       |                                         |
| earch |    |      |       |                                         |
| Pu    |    |      |       |                                         |
| blica |    |      |       |                                         |
| tions |    |      |       |                                         |
| (up   |    |      |       |                                         |
| to 5  |    |      |       |                                         |
| most  |    |      |       |                                         |
| rec   |    |      |       |                                         |
| ent): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Resp  |    |      |       |                                         |
| onsib |    |      |       |                                         |
| ility |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| pro   |    |      |       |                                         |
| gram: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| N     |    |      |       |                                         |
| ature |    |      |       |                                         |
| of    |    |      |       |                                         |
| c     |    |      |       |                                         |
| onsul |    |      |       |                                         |
| ting, |    |      |       |                                         |
| indus |    |      |       |                                         |
| trial |    |      |       |                                         |
| emplo |    |      |       |                                         |
| yment |    |      |       |                                         |
| or    |    |      |       |                                         |
| other |    |      |       |                                         |
| non-  |    |      |       |                                         |
| unive |    |      |       |                                         |
| rsity |    |      |       |                                         |
| act   |    |      |       |                                         |
| ivity |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| past  |    |      |       |                                         |
| two-  |    |      |       |                                         |
| three |    |      |       |                                         |
| y     |    |      |       |                                         |
| ears: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Any   |    |      |       |                                         |
| other |    |      |       |                                         |
| pert  |    |      |       |                                         |
| inent |    |      |       |                                         |
| data: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+

+-------+----+------+-------+-----------------------------------------+
| I     | [  |      |       |                                         |
| nstit |    |      |       |                                         |
| ution |    |      |       |                                         |
|       |  ] |      |       |                                         |
|       | {. |      |       |                                         |
|       | un |      |       |                                         |
|       | de |      |       |                                         |
|       | rl |      |       |                                         |
|       | in |      |       |                                         |
|       | e} |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| **    |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| E**   |    |      |       |                                         |
|       |    |      |       |                                         |
| **FA  |    |      |       |                                         |
| CULTY |    |      |       |                                         |
| VITAE |    |      |       |                                         |
| FOR   |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| D     |    |      |       |                                         |
| LIST  |    |      |       |                                         |
| ING** |    |      |       |                                         |
|       |    |      |       |                                         |
| *     |    |      |       |                                         |
| *(Com |    |      |       |                                         |
| plete |    |      |       |                                         |
| this  |    |      |       |                                         |
| form  |    |      |       |                                         |
| or    |    |      |       |                                         |
| pr    |    |      |       |                                         |
| ovide |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| v     |    |      |       |                                         |
| itae. |    |      |       |                                         |
| P     |    |      |       |                                         |
| lease |    |      |       |                                         |
| limit |    |      |       |                                         |
| to    |    |      |       |                                         |
| one   |    |      |       |                                         |
| page  |    |      |       |                                         |
| per   |    |      |       |                                         |
| perso |    |      |       |                                         |
| n.)** |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| For   |    |      |       |                                         |
| all   |    |      |       |                                         |
| cu    |    |      |       |                                         |
| rrent |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| comm  |    |      |       |                                         |
| itted |    |      |       |                                         |
| to    |    |      |       |                                         |
| F     |    |      |       |                                         |
| usion |    |      |       |                                         |
| E     |    |      |       |                                         |
| nergy |    |      |       |                                         |
| Sci   |    |      |       |                                         |
| ences |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Name: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Aca   |    |      |       |                                         |
| demic |    |      |       |                                         |
| Rank: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Date  |    |      |       |                                         |
| of    |    |      |       |                                         |
| In    |    |      |       |                                         |
| itial |    |      |       |                                         |
| Ap    |    |      |       |                                         |
| point |    |      |       |                                         |
| ment: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| De    |    |      |       |                                         |
| grees |    |      |       |                                         |
| (     |    |      |       |                                         |
| where |    |      |       |                                         |
| and   |    |      |       |                                         |
| when  |    |      |       |                                         |
| c     |    |      |       |                                         |
| onfer |    |      |       |                                         |
| red): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Field |    |      |       |                                         |
| of    |    |      |       |                                         |
| Spec  |    |      |       |                                         |
| ializ |    |      |       |                                         |
| ation |    |      |       |                                         |
| and   |    |      |       |                                         |
| Areas |    |      |       |                                         |
| of    |    |      |       |                                         |
| Inte  |    |      |       |                                         |
| rest: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| S     |    |      |       |                                         |
| ignif |    |      |       |                                         |
| icant |    |      |       |                                         |
| Res   |    |      |       |                                         |
| earch |    |      |       |                                         |
| Pu    |    |      |       |                                         |
| blica |    |      |       |                                         |
| tions |    |      |       |                                         |
| (up   |    |      |       |                                         |
| to 5  |    |      |       |                                         |
| most  |    |      |       |                                         |
| rec   |    |      |       |                                         |
| ent): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Resp  |    |      |       |                                         |
| onsib |    |      |       |                                         |
| ility |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| pro   |    |      |       |                                         |
| gram: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| N     |    |      |       |                                         |
| ature |    |      |       |                                         |
| of    |    |      |       |                                         |
| c     |    |      |       |                                         |
| onsul |    |      |       |                                         |
| ting, |    |      |       |                                         |
| indus |    |      |       |                                         |
| trial |    |      |       |                                         |
| emplo |    |      |       |                                         |
| yment |    |      |       |                                         |
| or    |    |      |       |                                         |
| other |    |      |       |                                         |
| non-  |    |      |       |                                         |
| unive |    |      |       |                                         |
| rsity |    |      |       |                                         |
| act   |    |      |       |                                         |
| ivity |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| past  |    |      |       |                                         |
| two-  |    |      |       |                                         |
| three |    |      |       |                                         |
| y     |    |      |       |                                         |
| ears: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Any   |    |      |       |                                         |
| other |    |      |       |                                         |
| pert  |    |      |       |                                         |
| inent |    |      |       |                                         |
| data: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+

+-------+----+------+-------+-----------------------------------------+
| I     | [  |      |       |                                         |
| nstit |    |      |       |                                         |
| ution |    |      |       |                                         |
|       |  ] |      |       |                                         |
|       | {. |      |       |                                         |
|       | un |      |       |                                         |
|       | de |      |       |                                         |
|       | rl |      |       |                                         |
|       | in |      |       |                                         |
|       | e} |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| **    |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| E**   |    |      |       |                                         |
|       |    |      |       |                                         |
| **FA  |    |      |       |                                         |
| CULTY |    |      |       |                                         |
| VITAE |    |      |       |                                         |
| FOR   |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| D     |    |      |       |                                         |
| LIST  |    |      |       |                                         |
| ING** |    |      |       |                                         |
|       |    |      |       |                                         |
| *     |    |      |       |                                         |
| *(Com |    |      |       |                                         |
| plete |    |      |       |                                         |
| this  |    |      |       |                                         |
| form  |    |      |       |                                         |
| or    |    |      |       |                                         |
| pr    |    |      |       |                                         |
| ovide |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| v     |    |      |       |                                         |
| itae. |    |      |       |                                         |
| P     |    |      |       |                                         |
| lease |    |      |       |                                         |
| limit |    |      |       |                                         |
| to    |    |      |       |                                         |
| one   |    |      |       |                                         |
| page  |    |      |       |                                         |
| per   |    |      |       |                                         |
| perso |    |      |       |                                         |
| n.)** |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| For   |    |      |       |                                         |
| all   |    |      |       |                                         |
| cu    |    |      |       |                                         |
| rrent |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| comm  |    |      |       |                                         |
| itted |    |      |       |                                         |
| to    |    |      |       |                                         |
| F     |    |      |       |                                         |
| usion |    |      |       |                                         |
| E     |    |      |       |                                         |
| nergy |    |      |       |                                         |
| Sci   |    |      |       |                                         |
| ences |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Name: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Aca   |    |      |       |                                         |
| demic |    |      |       |                                         |
| Rank: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Date  |    |      |       |                                         |
| of    |    |      |       |                                         |
| In    |    |      |       |                                         |
| itial |    |      |       |                                         |
| Ap    |    |      |       |                                         |
| point |    |      |       |                                         |
| ment: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| De    |    |      |       |                                         |
| grees |    |      |       |                                         |
| (     |    |      |       |                                         |
| where |    |      |       |                                         |
| and   |    |      |       |                                         |
| when  |    |      |       |                                         |
| c     |    |      |       |                                         |
| onfer |    |      |       |                                         |
| red): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Field |    |      |       |                                         |
| of    |    |      |       |                                         |
| Spec  |    |      |       |                                         |
| ializ |    |      |       |                                         |
| ation |    |      |       |                                         |
| and   |    |      |       |                                         |
| Areas |    |      |       |                                         |
| of    |    |      |       |                                         |
| Inte  |    |      |       |                                         |
| rest: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| S     |    |      |       |                                         |
| ignif |    |      |       |                                         |
| icant |    |      |       |                                         |
| Res   |    |      |       |                                         |
| earch |    |      |       |                                         |
| Pu    |    |      |       |                                         |
| blica |    |      |       |                                         |
| tions |    |      |       |                                         |
| (up   |    |      |       |                                         |
| to 5  |    |      |       |                                         |
| most  |    |      |       |                                         |
| rec   |    |      |       |                                         |
| ent): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Resp  |    |      |       |                                         |
| onsib |    |      |       |                                         |
| ility |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| pro   |    |      |       |                                         |
| gram: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| N     |    |      |       |                                         |
| ature |    |      |       |                                         |
| of    |    |      |       |                                         |
| c     |    |      |       |                                         |
| onsul |    |      |       |                                         |
| ting, |    |      |       |                                         |
| indus |    |      |       |                                         |
| trial |    |      |       |                                         |
| emplo |    |      |       |                                         |
| yment |    |      |       |                                         |
| or    |    |      |       |                                         |
| other |    |      |       |                                         |
| non-  |    |      |       |                                         |
| unive |    |      |       |                                         |
| rsity |    |      |       |                                         |
| act   |    |      |       |                                         |
| ivity |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| past  |    |      |       |                                         |
| two-  |    |      |       |                                         |
| three |    |      |       |                                         |
| y     |    |      |       |                                         |
| ears: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Any   |    |      |       |                                         |
| other |    |      |       |                                         |
| pert  |    |      |       |                                         |
| inent |    |      |       |                                         |
| data: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+

+-------+----+------+-------+-----------------------------------------+
| I     | [  |      |       |                                         |
| nstit |    |      |       |                                         |
| ution |    |      |       |                                         |
|       |  ] |      |       |                                         |
|       | {. |      |       |                                         |
|       | un |      |       |                                         |
|       | de |      |       |                                         |
|       | rl |      |       |                                         |
|       | in |      |       |                                         |
|       | e} |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| **    |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| E**   |    |      |       |                                         |
|       |    |      |       |                                         |
| **FA  |    |      |       |                                         |
| CULTY |    |      |       |                                         |
| VITAE |    |      |       |                                         |
| FOR   |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| D     |    |      |       |                                         |
| LIST  |    |      |       |                                         |
| ING** |    |      |       |                                         |
|       |    |      |       |                                         |
| *     |    |      |       |                                         |
| *(Com |    |      |       |                                         |
| plete |    |      |       |                                         |
| this  |    |      |       |                                         |
| form  |    |      |       |                                         |
| or    |    |      |       |                                         |
| pr    |    |      |       |                                         |
| ovide |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| v     |    |      |       |                                         |
| itae. |    |      |       |                                         |
| P     |    |      |       |                                         |
| lease |    |      |       |                                         |
| limit |    |      |       |                                         |
| to    |    |      |       |                                         |
| one   |    |      |       |                                         |
| page  |    |      |       |                                         |
| per   |    |      |       |                                         |
| perso |    |      |       |                                         |
| n.)** |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| For   |    |      |       |                                         |
| all   |    |      |       |                                         |
| cu    |    |      |       |                                         |
| rrent |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| comm  |    |      |       |                                         |
| itted |    |      |       |                                         |
| to    |    |      |       |                                         |
| F     |    |      |       |                                         |
| usion |    |      |       |                                         |
| E     |    |      |       |                                         |
| nergy |    |      |       |                                         |
| Sci   |    |      |       |                                         |
| ences |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Name: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Aca   |    |      |       |                                         |
| demic |    |      |       |                                         |
| Rank: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Date  |    |      |       |                                         |
| of    |    |      |       |                                         |
| In    |    |      |       |                                         |
| itial |    |      |       |                                         |
| Ap    |    |      |       |                                         |
| point |    |      |       |                                         |
| ment: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| De    |    |      |       |                                         |
| grees |    |      |       |                                         |
| (     |    |      |       |                                         |
| where |    |      |       |                                         |
| and   |    |      |       |                                         |
| when  |    |      |       |                                         |
| c     |    |      |       |                                         |
| onfer |    |      |       |                                         |
| red): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Field |    |      |       |                                         |
| of    |    |      |       |                                         |
| Spec  |    |      |       |                                         |
| ializ |    |      |       |                                         |
| ation |    |      |       |                                         |
| and   |    |      |       |                                         |
| Areas |    |      |       |                                         |
| of    |    |      |       |                                         |
| Inte  |    |      |       |                                         |
| rest: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| S     |    |      |       |                                         |
| ignif |    |      |       |                                         |
| icant |    |      |       |                                         |
| Res   |    |      |       |                                         |
| earch |    |      |       |                                         |
| Pu    |    |      |       |                                         |
| blica |    |      |       |                                         |
| tions |    |      |       |                                         |
| (up   |    |      |       |                                         |
| to 5  |    |      |       |                                         |
| most  |    |      |       |                                         |
| rec   |    |      |       |                                         |
| ent): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Resp  |    |      |       |                                         |
| onsib |    |      |       |                                         |
| ility |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| pro   |    |      |       |                                         |
| gram: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| N     |    |      |       |                                         |
| ature |    |      |       |                                         |
| of    |    |      |       |                                         |
| c     |    |      |       |                                         |
| onsul |    |      |       |                                         |
| ting, |    |      |       |                                         |
| indus |    |      |       |                                         |
| trial |    |      |       |                                         |
| emplo |    |      |       |                                         |
| yment |    |      |       |                                         |
| or    |    |      |       |                                         |
| other |    |      |       |                                         |
| non-  |    |      |       |                                         |
| unive |    |      |       |                                         |
| rsity |    |      |       |                                         |
| act   |    |      |       |                                         |
| ivity |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| past  |    |      |       |                                         |
| two-  |    |      |       |                                         |
| three |    |      |       |                                         |
| y     |    |      |       |                                         |
| ears: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Any   |    |      |       |                                         |
| other |    |      |       |                                         |
| pert  |    |      |       |                                         |
| inent |    |      |       |                                         |
| data: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+

+-------+----+------+-------+-----------------------------------------+
| I     | [  |      |       |                                         |
| nstit |    |      |       |                                         |
| ution |    |      |       |                                         |
|       |  ] |      |       |                                         |
|       | {. |      |       |                                         |
|       | un |      |       |                                         |
|       | de |      |       |                                         |
|       | rl |      |       |                                         |
|       | in |      |       |                                         |
|       | e} |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| **    |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| E**   |    |      |       |                                         |
|       |    |      |       |                                         |
| **FA  |    |      |       |                                         |
| CULTY |    |      |       |                                         |
| VITAE |    |      |       |                                         |
| FOR   |    |      |       |                                         |
| TABLE |    |      |       |                                         |
| D     |    |      |       |                                         |
| LIST  |    |      |       |                                         |
| ING** |    |      |       |                                         |
|       |    |      |       |                                         |
| *     |    |      |       |                                         |
| *(Com |    |      |       |                                         |
| plete |    |      |       |                                         |
| this  |    |      |       |                                         |
| form  |    |      |       |                                         |
| or    |    |      |       |                                         |
| pr    |    |      |       |                                         |
| ovide |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| v     |    |      |       |                                         |
| itae. |    |      |       |                                         |
| P     |    |      |       |                                         |
| lease |    |      |       |                                         |
| limit |    |      |       |                                         |
| to    |    |      |       |                                         |
| one   |    |      |       |                                         |
| page  |    |      |       |                                         |
| per   |    |      |       |                                         |
| perso |    |      |       |                                         |
| n.)** |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| For   |    |      |       |                                         |
| all   |    |      |       |                                         |
| cu    |    |      |       |                                         |
| rrent |    |      |       |                                         |
| fa    |    |      |       |                                         |
| culty |    |      |       |                                         |
| comm  |    |      |       |                                         |
| itted |    |      |       |                                         |
| to    |    |      |       |                                         |
| F     |    |      |       |                                         |
| usion |    |      |       |                                         |
| E     |    |      |       |                                         |
| nergy |    |      |       |                                         |
| Sci   |    |      |       |                                         |
| ences |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Name: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Aca   |    |      |       |                                         |
| demic |    |      |       |                                         |
| Rank: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Date  |    |      |       |                                         |
| of    |    |      |       |                                         |
| In    |    |      |       |                                         |
| itial |    |      |       |                                         |
| Ap    |    |      |       |                                         |
| point |    |      |       |                                         |
| ment: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| De    |    |      |       |                                         |
| grees |    |      |       |                                         |
| (     |    |      |       |                                         |
| where |    |      |       |                                         |
| and   |    |      |       |                                         |
| when  |    |      |       |                                         |
| c     |    |      |       |                                         |
| onfer |    |      |       |                                         |
| red): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Field |    |      |       |                                         |
| of    |    |      |       |                                         |
| Spec  |    |      |       |                                         |
| ializ |    |      |       |                                         |
| ation |    |      |       |                                         |
| and   |    |      |       |                                         |
| Areas |    |      |       |                                         |
| of    |    |      |       |                                         |
| Inte  |    |      |       |                                         |
| rest: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| S     |    |      |       |                                         |
| ignif |    |      |       |                                         |
| icant |    |      |       |                                         |
| Res   |    |      |       |                                         |
| earch |    |      |       |                                         |
| Pu    |    |      |       |                                         |
| blica |    |      |       |                                         |
| tions |    |      |       |                                         |
| (up   |    |      |       |                                         |
| to 5  |    |      |       |                                         |
| most  |    |      |       |                                         |
| rec   |    |      |       |                                         |
| ent): |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Resp  |    |      |       |                                         |
| onsib |    |      |       |                                         |
| ility |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| pro   |    |      |       |                                         |
| gram: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| N     |    |      |       |                                         |
| ature |    |      |       |                                         |
| of    |    |      |       |                                         |
| c     |    |      |       |                                         |
| onsul |    |      |       |                                         |
| ting, |    |      |       |                                         |
| indus |    |      |       |                                         |
| trial |    |      |       |                                         |
| emplo |    |      |       |                                         |
| yment |    |      |       |                                         |
| or    |    |      |       |                                         |
| other |    |      |       |                                         |
| non-  |    |      |       |                                         |
| unive |    |      |       |                                         |
| rsity |    |      |       |                                         |
| act   |    |      |       |                                         |
| ivity |    |      |       |                                         |
| in    |    |      |       |                                         |
| the   |    |      |       |                                         |
| past  |    |      |       |                                         |
| two-  |    |      |       |                                         |
| three |    |      |       |                                         |
| y     |    |      |       |                                         |
| ears: |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+
| Any   |    |      |       |                                         |
| other |    |      |       |                                         |
| pert  |    |      |       |                                         |
| inent |    |      |       |                                         |
| data: |    |      |       |                                         |
|       |    |      |       |                                         |
+-------+----+------+-------+-----------------------------------------+

+-------+---+-----------+----------+------------+----------+----------+
| I     | [ |           |          |            |          |          |
| nstit |   |           |          |            |          |          |
| ution |   |           |          |            |          |          |
|       |   |           |          |            |          |          |
|       |   |           |          |            |          |          |
|       |   |           |          |            |          |          |
|       | ] |           |          |            |          |          |
|       | { |           |          |            |          |          |
|       | . |           |          |            |          |          |
|       | u |           |          |            |          |          |
|       | n |           |          |            |          |          |
|       | d |           |          |            |          |          |
|       | e |           |          |            |          |          |
|       | r |           |          |            |          |          |
|       | l |           |          |            |          |          |
|       | i |           |          |            |          |          |
|       | n |           |          |            |          |          |
|       | e |           |          |            |          |          |
|       | } |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
| **    |   |           |          |            |          |          |
| TABLE |   |           |          |            |          |          |
| F**   |   |           |          |            |          |          |
|       |   |           |          |            |          |          |
| **RES |   |           |          |            |          |          |
| EARCH |   |           |          |            |          |          |
| PRO   |   |           |          |            |          |          |
| JECTS |   |           |          |            |          |          |
| RE    |   |           |          |            |          |          |
| LATED |   |           |          |            |          |          |
| TO    |   |           |          |            |          |          |
| F     |   |           |          |            |          |          |
| USION |   |           |          |            |          |          |
| E     |   |           |          |            |          |          |
| NERGY |   |           |          |            |          |          |
| SCIEN |   |           |          |            |          |          |
| CES** |   |           |          |            |          |          |
|       |   |           |          |            |          |          |
| **    |   |           |          |            |          |          |
| (past |   |           |          |            |          |          |
| five  |   |           |          |            |          |          |
| ye    |   |           |          |            |          |          |
| ars - |   |           |          |            |          |          |
| you   |   |           |          |            |          |          |
| may   |   |           |          |            |          |          |
| limit |   |           |          |            |          |          |
| to    |   |           |          |            |          |          |
| s     |   |           |          |            |          |          |
| ix)** |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
| Title |   | Principal | Sponsor  | Scope      | Funding  | Term of  |
|       |   | Inv       |          | /Objective | Level    | Project  |
|       |   | estigator |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+
|       |   |           |          |            |          |          |
+-------+---+-----------+----------+------------+----------+----------+

+-------+---------------+----------------------+----------------------+
| I     | [             |                      |                      |
| nstit | ]{.underline} |                      |                      |
| ution |               |                      |                      |
+-------+---------------+----------------------+----------------------+
| **    |               |                      |                      |
| TABLE |               |                      |                      |
| Ga**  |               |                      |                      |
|       |               |                      |                      |
| **D   |               |                      |                      |
| ESCRI |               |                      |                      |
| PTION |               |                      |                      |
| OF    |               |                      |                      |
| *RESE |               |                      |                      |
| ARCH* |               |                      |                      |
| EQUI  |               |                      |                      |
| PMENT |               |                      |                      |
| AND   |               |                      |                      |
| FACIL |               |                      |                      |
| ITIES |               |                      |                      |
| RE    |               |                      |                      |
| LATED |               |                      |                      |
| TO    |               |                      |                      |
| F     |               |                      |                      |
| USI0N |               |                      |                      |
| E     |               |                      |                      |
| NERGY |               |                      |                      |
| SCIEN |               |                      |                      |
| CES** |               |                      |                      |
|       |               |                      |                      |
| *     |               |                      |                      |
| *(may |               |                      |                      |
| in    |               |                      |                      |
| clude |               |                      |                      |
| on-   |               |                      |                      |
| a     |               |                      |                      |
| nd/or |               |                      |                      |
| off-c |               |                      |                      |
| ampus |               |                      |                      |
| eq    |               |                      |                      |
| uipme |               |                      |                      |
| nt)** |               |                      |                      |
+-------+---------------+----------------------+----------------------+
| Equ   |               | Location (on- and/or | Description of       |
| ipmen |               | off-campus)          | Equipment/           |
| t/Fac |               |                      |                      |
| ility |               |                      | Facility Utilization |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+
|       |               |                      |                      |
+-------+---------------+----------------------+----------------------+

+--------+-------------+-----------------------+-----------------------+
| Insti  | [     ]{    |                       |                       |
| tution | .underline} |                       |                       |
+--------+-------------+-----------------------+-----------------------+
| *      |             |                       |                       |
| *TABLE |             |                       |                       |
| Gb**   |             |                       |                       |
|        |             |                       |                       |
| *      |             |                       |                       |
| *DESCR |             |                       |                       |
| IPTION |             |                       |                       |
| OF     |             |                       |                       |
| PER    |             |                       |                       |
| TINENT |             |                       |                       |
| (EXI   |             |                       |                       |
| STING) |             |                       |                       |
| *IN    |             |                       |                       |
| STRUCT |             |                       |                       |
| IONAL* |             |                       |                       |
| EQUIP  |             |                       |                       |
| MENT** |             |                       |                       |
|        |             |                       |                       |
| **AND  |             |                       |                       |
| FACI   |             |                       |                       |
| LITIES |             |                       |                       |
| R      |             |                       |                       |
| ELATED |             |                       |                       |
| TO     |             |                       |                       |
| FUSION |             |                       |                       |
| ENERGY |             |                       |                       |
| SCIE   |             |                       |                       |
| NCES** |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
| I      |             | Description of        | Location              |
| temize |             | Equipment/Facility    |                       |
| Equipm |             | Utilization           | (on- and/or           |
| ent/Fa |             |                       | off-campus)           |
| cility |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+
|        |             |                       |                       |
+--------+-------------+-----------------------+-----------------------+

+-------+--------------------------------------------------------------+
| I     | **[     ]{.underline}**                                      |
| nstit |                                                              |
| ution |                                                              |
+-------+--------------------------------------------------------------+
| **    |                                                              |
| TABLE |                                                              |
| H**   |                                                              |
|       |                                                              |
| **    |                                                              |
| ADDIT |                                                              |
| IONAL |                                                              |
| MAT   |                                                              |
| ERIAL |                                                              |
| CONSI |                                                              |
| DERED |                                                              |
| IMPO  |                                                              |
| RTANT |                                                              |
| IN    |                                                              |
| ASSE  |                                                              |
| SSING |                                                              |
| THE   |                                                              |
| UNI   |                                                              |
| VERSI |                                                              |
| TY\'S |                                                              |
| ELI   |                                                              |
| GIBIL |                                                              |
| ITY** |                                                              |
|       |                                                              |
| *     |                                                              |
| *(use |                                                              |
| addit |                                                              |
| ional |                                                              |
| s     |                                                              |
| heet, |                                                              |
| if    |                                                              |
| ne    |                                                              |
| eded, |                                                              |
| but   |                                                              |
| li    |                                                              |
| mited |                                                              |
| to    |                                                              |
| two   |                                                              |
| pag   |                                                              |
| es)** |                                                              |
+-------+--------------------------------------------------------------+
|       |                                                              |
+-------+--------------------------------------------------------------+