UCB College of Chemistry


College of Chemistry Alumni Questionnaire


 
Tell us about yourself...
Title
First Middle Last
Previous Name (if applicable)
UC Berkeley Degree(s)...
Degree One
Degree Two
Major
Degree
Year
Semester
Research Director
Degree(s) From Other Institutions...
Degree One
Degree Two
Institution
Major
Degree
Year
Email Address: 

Home Address / Information...
New?   Yes   No  
Street
City
State / Province
Zip / Postal
Country
Phone
 Fax

Work - School Address / Information...
New?   Yes   No  
Position
Start Date
Job Function
Job Type:
Name of
Organization
Division:
Street
City
State / Province
Zip / Postal
Country
Phone
Fax
Send Mail To:  Home    Work
Spouse or Partner's Name:     
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...



Alumni Association


     Yes    No      I want to join the Alumni Association (It's free!)


I want to help by:

         Yes    No      Participating in future planning for the association


         Yes    No      Planning events in my area (with the assistance of the college)


I am interested in participating in the following:

         Yes    No      Lectures or Symposia


         Yes    No      Social Events


         Yes    No      Career Networking


         Yes  No      Graduate student recruitment


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





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Application Technical Contact
 
Last Modified:
1/16/08 2:30 PM

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