Individual Questionnaire for CS 590: Summer Directed Research - CPT in Software Engineering

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Personal Information

First Name*:
Middle Initial:
Last Name*:
Student ID*: xxx-xx-xxxx
Sex*:	MF

Contact Information

Preferred Email address*:
USC SCF UserName*:	@scf.usc.edu
Daytime Phone Number*: (xxx) xxx-xxxx
Fax Number: (xxx) xxx-xxxx
Personal Web Page URL:

Student Information

I am specializing in Software Engineering	Yes No
Current Degree Objective	MS PhD
English Proficiency Level*	Select One  Excellent  Moderate  Beginner

Your Work Information

Company*

Department*

Your Title*

Your Job Description*

Company URL

Supervisor Information

First Name*:

Middle Initial:

Last Name*:

Title*

Email address*:

Daytime Phone Number*: (xxx) xxx-xxxx

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