| First Name: |
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| Last Name: |
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| Maiden Name: |
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| Email Address: |
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| Phone Number (incl. Area Code): |
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| Were you a BIO Major at SBU? |
Yes No |
| or a BIO Minor? |
Yes No |
| If BIO Major, which BIO track did you follow at SBU? |
If "Other" BIO Track, please explain:
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| When did you graduate from SBU? |
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| Did you continue education after SBU? |
Yes No |
| If Yes, what kind of education? |
If "Other" education, please explain:
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| What is your current profession? |
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| Are you interested in coming to SBU to discuss careers with current BIO students? |
Yes No |
| Some additional ways you might like to help UG BIO at SBU (please indicate any preferences): |
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| Would you like to visit us? |
Yes No |
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Your Question(s)/Comment(s):
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Your information will be submitted to:
UG BIO Advisor Ellen Lopez
G-04 CMM/BLL
UG BIO/ SBU
Stony Brook,
NY 11794-5110
631-632-8543 (phone)
631-632-1347 (fax)
ellen.lopez@stonybrook.edu
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