Title  Dr.  Mr.  Ms.  Mrs.

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 graduated with your engineering degree)

Degree B.A. in physics     B.A. in mathematics-physics
              3-2 engineering  Physics teaching

Home address
(Line 1) 
(Line 2) 
     City    State    Zip 
Telephone number (xxx-xxx-xxxx) 
E-mail 

Enter your e-mail address again if you want it included on the website
E-mail 

Web page 

Received Ph.D.   Yes  No  Pursuing
Received M.A./M.S. Yes  No  Pursuing
Received teaching certificate  Yes  No Pursuing

Post graduate institutions
(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

Institution 2 
Major    Degree    Year earned     Pursuing

Institution 3: 
Major    Degree    Year earned     Pursuing

Work title 
Employer  
Work address
(Line 1) 
(Line 2) 
     City    State    Zip 
Telephone number (xxx-xxx-xxxx) 
Work e-mail 

Would you be willing to return to IC to talk to 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


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