UCB College of Chemistry

ALUMNI QUESTIONNAIRE
        * = Required Field
TELL US ABOUT YOURSELF
Title
First Name*
Middle Name
Last Name*
Previous Name (if applicable)
Spouse's or Partner's Name
 
UC BERKELEY DEGREE(S)
  Degree One Degree Two
Major*
Degree*
Year*
Semester
Research Director
 
DEGREES FROM OTHER INSTITUTIONS
  Degree One Degree Two
Institution
Major
Degree
Year
 
 
CONTACT INFORMATION
Email*
Home Address New? Yes No
Street
City
State
Zip/Postal
Country
Phone
 
Work/School Address New? Yes No
Position
Start Date
Job Function
Job Type
Name of Organization
Division
Street
City
State
Zip
Country
Phone
Send Mail To Home Work
 
CONTACT PERSON
Name and address of someone who will always know how to contact you
 
CLASS NOTES
Tell us your news! Recent promotions, family additions, exciting trips, etc...
 
COLLEGE OF CHEMISTRY ALUMNI ASSOCIATION/ACTIVITIES
I want to join the Alumni Association (it's free!) Yes No
I want to help by:
Participating in future planning for the association Yes No
Planning events in my area (with the assistance of the college) Yes No
I am interested in participating in the following:
Lectures or Symposia Yes No
Social Events Yes No
Career Networking Yes No
Grad student recruitment Yes No
   
I grant permission for the publication of my news, but NOT my address information, in the "Class Notes" section of the College of Chemistry News Journal
Yes, I grant such permission No, I do not grant such permission



Application Technical Contact

© 2014 UC Regents

Last Modified:
09/18/2013 01:49:37 PM