============================================================================ DEPARTMENT OF GEOSCIENCES ALUMNI REPORT ============================================================================ Instructions: Fill the following form out as completely as possible then either fax it to (631) 632-8240, or send it to Stony Brook University Department of Geosciences 255 ESS Building Stony Brook, NY 11794-2100 Your Information: ============================================================================ Date: ________________ Name: ____________________________________________________________________ Maiden Name (if applicable): _____________________________________________ SBU Graduation Year(s): ________________________________________________ I am: [ ] Alumnus/a [ ] Former Student [ ] Friend [ ] Student [ ] Parent [ ] Faculty/Staff Home Address - Street: ___________________________________________________ City/State/Zip: ___________________________________________ Country: __________________________________________________ Home Phone: ______________________________________________________________ Home FAX: ________________________________________________________________ Home E-mail: _____________________________________________________________ Employer: ________________________________________________________________ Occupation/Title: ________________________________________________________ Business Address - Street: _______________________________________________ City/State/Zip: _______________________________________ Country: ______________________________________________ Business Phone: __________________________________________________________ Business FAX: ____________________________________________________________ Business E-mail: _________________________________________________________ INFORMATION YOU WOULD LIKE TO SHARE? ============================================================================ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________