I certify that I have personally examined and am familiar with the information in this application and believe that the information submitted is accurate and complete. I am aware that making a false statement or misrepresentation in this application is grounds for denying or revoking this permit.

that over the course of 24 weeks the Washington, D.C., Department of Health creates weekly alert levels for a disease for each ZIP Code in the city. This fictional data is displayed in Table 1. The ring map in Figure 1 shows the same hypothetical information that is contained in the table. For each ZIP Code

inside and outside the European Economic Area where there may be less stringent data protection laws). Wherever it is processed, your information will be protected by a strict code of secrecy and security which all members of the HSBC Group, their staff and any third parties are subject to and will only

The loosening of acetabular component has been classically described as a more frequent complication than the loosening of femoral component, specially in cemented prostheses(7). Such description induced the popularization of the usage of non-ce-

Are you a United States citizen, national, or lawful permanent resident alien? Yes No If you are a lawful permanent resident alien and you received your card after January 1987, what is your registration number and card expiration date? ___________________________ SOCIAL SECURTY NUMBER: ______-_____-_______ (If ISU Student) 991 Number: 991-_____-_______

Processing Fees at the Rate currently charged by the APCP will be Assessed at the End of the Review (unless no permit is

Are you a United States citizen, national, or lawful permanent resident alien? Yes No If you are a lawful permanent resident alien and you received your card after January 1987, what is your registration number and card expiration date? ___________________________ SOCIAL SECURTY NUMBER: ______-_____-_______ (If ISU Student) 991 Number: 991-_____-_______

Are you a United States citizen, national, or lawful permanent resident alien? Yes No If you are a lawful permanent resident alien and you received your card after January 1987, what is your registration number and card expiration date? ___________________________ SOCIAL SECURTY NUMBER: ______-_____-_______ (If ISU Student) 991 Number: 991-_____-_______

Application for Graduate Assistantship (Submit with Application Form for Graduate Studies) Note: According to university regulations, students who are awarded a full-time graduate assistantship are expected to work for 20 hours per week in an academic department. Students who are awarded a half-time graduate assistantship are expected to work for 10 hours per week in an academic department. The award covers tuition costs and partial living expenses. Students are usually selected on the basis of a high academic record and their value to the department. Graduate assistants should not be engaged in any part-time or full-time work besides their duty at the faculty and they should sign a statement to that effect. I. Personal information

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