Form

Ithaca College Physics Alumni Web Form
The information you are entering on this page will be posted on the physics website in a few days. Thank you for taking the time to give us your update.
NOTE: Please fill out all of the relevant sections. The information you send us will be reviewed and then copied directly into the alumni database. Information currently in the database will be overwritten by your new information.

First Name *
Middle Initial
Maiden Name
Last Name *
Nick-name or name you prefer
Graduation Year *
If 3-2 Engineering please type the year you graduate with your engineering degree
Degree *	B.A. in Physics B.S. in Physics B.A. in Math-Physics B.A. / 3-2 Engineering B.A. with Physics Teaching
Address
Address (line2)
City
State
Country
Zip Code
Telephone Number
E-mail
Webpage

Employer
Work Title
Work Address
CIty
State
Country
Zip Code

Received Ph.D.	Yes No Pursuing
Recieved M.A./M.S.	Yes No Pursuing
Recieved Teaching Certificate	Yes No Pursuing

Most Recent Post Graduate Institution (If you are currently pursuing your degree, leave the "year earned" blank and click on the "pursuing" button.
Institution 1
Major
Degree
Year Earned
	Pursuing

Would you be willing to return to IC to talk with students by either giving one of our seminars or meeting informally with interested students?
	Yes No
Please tell us about recent changes and happenings in your life:

If you have a current photo of yourself (and your family) that you would like us to include on the IC-physics alumni web page, please send it as a high-quality, large-format jpg or tiff in an attachment to an e-mail to Professor Michael Rogers: mrogers@ithaca.edu