NATIONAL TAX ASSOCIATION
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DOCTORAL DISSERTATION AWARDS

ENTRY APPLICATION FORM. A completed Entry Application Form must be submitted to the Chairperson of the entrant's doctoral dissertation committee. The entrant should also submit a copy of the dissertation to National Tax Association, 725 15th Street NW #600, Washington DC, 20005-2109. The deadline for submission is June 15, 2008

(Please print or type.)

1. Name ______________________________________________________________
                    Last                                   First                                Middle                   

2. Present position or status___________________________________________

3. Present address (including telephone and E-Mail)________________________________

___________________________________________________________________________

____________________________________________________________________________

4. Permanent address and telephone (if different)________________________________

___________________________________________________________________________

5. Social Security Number ____________________________

6. Educational Background. List institutions of higher education attended starting with the most recent.

Institution                                     Major Field(s)                        Period Attended                Degree Earned:

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

7. Date Ph.D degree conferred (if applicable) ____________________________

8. List names and position of members of doctoral dissertation committee

Chairperson______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Date________________________ Signature_____________________________

 

This form must be submitted to and returned by the Chairperson of dissertation committee.

 

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