Alumni Update Form

Dear Chemistry Alumni,

To help the Department of Chemistry at Millersville University keep up to date with alumni, we request you submit the following information:

* Required information

Academic Information

Name: *

Class Year: *

MU Degree:  BS BS/Biochemistry Option BS/Environmental Option BS/Nanotechnology Option BS/Polymer Option BSE BA *

Post-Baccalaureate Degree:  None MS PhD other *

Institution, year of graduation:

If other degree, please indicate: 

Current Employer and Job Title :
*

How can we reach you?

Email: *

Street Address: *

City: *

State: *

Country:  *

Zip Code: *

Phone: 

Send news about yourself that you would like to share with us.

Add my name to the mailing list for the Alumni News Letter:  Yes No

Interest in returning to campus to give a seminar:  Yes No

Interest in homecoming reception:  Yes No

Permission to share your information with University Advancement:  Yes No