Profile Form

If you have any questions or concerns, please email uicomp-webservices@uic.edu.

Important Note: Please do not include personal cell phone numbers, personal email addresses, or other key details that may be private. Profile listings are publicly available pages and should not include items that would need to stay unlisted.

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Are you filling out this form on behalf of someone?

Yes - I am filling out this form on behalf of someone else

No - I am entering my own information

Submitter's Name:

Submitter's Email:(Required)

Do you, or the person you're submitting this for, have an existing directory profile?

Yes

I'm not sure

Please paste the link for the URL to your directory profile here:

Profile Listing Information:

Please Note:

All information below this line is information that should go directly onto the profile listing. If you are entering your name as a submitter, please enter that above this line. All information below is for what should be displayed on the profile listing being submitted.

First Name:(Required)

Middle Name:

Last Name:(Required)

Credentials:(Required)

Please type "N/A" if you do not have academic or professional credentials.

Profile Type:(Required)

Profile Photo (Headshot)

Max. file size: 15 MB.

Primary Title:(Required)

Primary title should be a single title that reflects the main UICOMP faculty responsibility or program/unit leadership role.

Secondary Title:

Any Additional Titles:

Department:(Required)

e.g., Department of Pediatrics * Pediatrics Residency. (Separate multiple departments by "*" asterisk)

Pronouns:

Examples: he/him/his, she/her/hers

Important Note:
Please do not include personal cell phone numbers, personal email addresses, or other key details that may be private. Profile listings are publicly available pages and should not include items that would need to stay unlisted.

Building & Room (Where You're Located):

Address (Where You're Located):

Office Phone:

Follow UIC standard example: 312-996-7000

Fax:

Follow UIC standard example: 312-996-7000

TTY:

Telecomm Device for deaf, hard of hearing, speech-impaired

Secondary Contact header:

Text entered here will appear above your secondary contact information.

Secondary Building & Room:

Secondary Address:

Secondary Office Phone

Follow UIC standard example: 312-996-7000

Secondary TTY:

Telecomm Device for deaf, hard of hearing, speech-impaired.

Email:

Typically left blank for faculty, although some in residency or fellowship leadership may wish to include.

Related Websites:

Max of 10. e.g. lab website, LinkedIn.

Site Title:

Site URL:

About:

Free-text section that can contain all bio information. However, preference is to use other specific fields when available, such as "Education" or "Licensures & Certifications." This is a good place to add content like "Why I Chose Peoria."

Selected Grants:

Max of 10.

Agency:

Title:

Role:

Selected Publications:

Max of 10.

Publications Aggregators:

Max of 10. PubMed, Google Scholar, etc.

Url:

Service to the Community

Leadership in the Profession:

Max of 10.

Role:

Organization:

Notable Honors:

Max of 10.

Year:

Name of the Award:

Awarding Agency:

Education:

Education Field Example

Residency: University of Illinois College of Medicine Peoria (Peoria, IL)

Medical School: Southern Illinois School of Medicine (Springfield, IL)

Undergraduate: Bradley University (Peoria, IL)

Licensures & Certifications:

Professional Memberships:

Selected Presentations:

Research Currently in Progress:

Intellectual Property:

Artistic and Professional Performances and Exhibits:

If you would like a copy of the submission, please enter the email address you would like that sent to.

Profile Form

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Profile Listing Information:

Please Note:

Education Field Example

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