PERSONAL PROFILE

First Name:                                  
 
Middle: 

Last Name:

Birth/Maiden Name:

Nickname:

Check One:
Ms.   Miss   Mrs.   Dr.   Rev.   Mr.                               

Birth Date: 

Home Address:
Street 

City                                 State     Zip
  
Home Phone:

Work Phone:

Cell Phone:

Fax:

Email Address:


Seasonal Address (if applicable):
From  to  (Dates)
Seasonal Phone:

Street 

City                                  State    Zip
  

EDUCATION

Wilson College Degree: 
     BA     BS    AS    AA     TIP    M.Ed. 
    Major:  
    Minor:  
    Graduation Year:

Other Undergraduate Study:
    Institution/City:   
    Major:                        
    Degree: 

If you did not graduate from Wilson College, what years(s) did you attend?

Postgraduate Work:
    Institution/City:   
    Major:                        
    Degree: 
    Year:     

    Institution/City:   
    Major:                        
    Degree: 
    Year:     

CAREER

Profession:

Current Position:

Employer:

Address:
   Street 
  
   City                                State   Zip
     
Teachers: Subject(s) taught: 
               Grade(s) taught:   

VOLUNTEER ACTIVITIES

Organizations/Causes:

Activities at Wilson College:

Positions held while at Wilson College:

AFFILIATIONS, HONORS, DISTINCTIONS SINCE GRADUATING/LEAVING WILSON COLLEGE

Please list below:

Are you interested in participating in any of the following Wilson College activities? Please check all that apply:

Internships:   January  Paid  Unpaid
                       Summer Paid  Unpaid 
                       Uncertain, will consider

Student Housing:    January    Spring    Summer
                               Fall           Other

 Student mentoring
 Fund raising
 Career networking

Would you be willing to speak to groups about:
   Wilson       Your career      Women's issues 
   The importance of education    Other

FAMILY

Spouse/Partner:

Highest level of education:

Profession:

Current position:

Employer:

Type of organization:


Children:
Please list first name, last name, gender and birth date.

Please name other relatives who attended Wilson College:
    Name/Relationship 
    Dates attended Wilson/Graduated 

    Name/Relationship 
    Dates attended Wilson/Graduated 

Please tell us about your experiences since leaving Wilson:

Date this form was completed: