Alumni Response Form

We really would like to know about you! Please take a few minutes to completethis questionnaire and click on the button at the bottom to send it backto us. Alternatively you may print it out and pop it in the mail (Chair, Departmentof Biochemistry & Biophysics, 2011 ALS Building, Oregon State University, Corvallis, OR 97331) or send itby FAX (541-737-0481).

YOUR NAME:

If a different name when at OSU, what was it then?:

BS, MS, PhD, other?: YEAR(S):

OTHER DEGREES (Degree, yr, institute):

HOME ADDRESS (The most "stable" address for mail):

Street/PO Box:

City, State, Zip:

PHONES: Home:Work:

FAX: E-MAIL:

EMPLOYMENT/CAREER: What occupies your time? What is your job or position?Are you a student, unemployed/looking, homemaker, retired, etc.:

WORK ADDRESS: Company:

Street/PO Box:

City, State, Zip:

Would you like more information about ways you could help supportBiochemistry & Biophysics through OSU's various programs forcharitable giving?
: Please click here if YES:

The space below is for your to comment on anything about yourrecollections,positive or negative, about your experiences in Biochemistry &Biophysics at OSU. Write anythingyou feel your former OSU colleagues and professors might like toknow about you since you were here and anything you think might behelpful. If the comments are confidential, please note that, otherwisewe will feel free to share them with students and faculty alike.