BSSO Alumni Association Contact Form

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Greetings fellow BSSO Alumni,
Thank you for agreeing to reconnect with the Black Student Science Organization of San Diego State University. The information you provide on this form is for internal use only. Your information will neither be sold to nor shared with any third party organizations or companies. All responses provided here will be kept confidential. This form is to serve as a means to collect the contact information of past and present BSSO Alumni.
Take a moment to visit the BSSO's website by pointing your browser to http://www.bsso.org and the BSSO Alumni Association's website at http://www.bssoaa.org

First Name *

Last Name (please provide the proper professional or personal suffix you desire to use, ex: Jr, Sr, MD, PhD, DO, JD, PharmD) *

Telephone Number *

Mailing Address *

What is your occupation? *

What is the name of the graduate or professional school you attended? *

What is the title of the graduate or professional program you attended? (if applicable)

How many years have you been practicing / working in your current field? *

In what year did you start your current career? *

Would you be willing to participate in an interview? (please check all that apply) *

Yes to an in-person interview (at a club meeting on campus or a potluck at Dr. Martin's home)

Yes to a recorded interview (captured by you, via cell phone, in landscape view using any smart-device )

Yes to a virtual interview (a real-time Skype/FaceTime interview to be recorded for use at a later time)

No to an interview

Required

How would you like to be contacted? (please check all that apply) *

by telephone

by text message

by email

by social media

Other:

Required

Are you on social media? (please check all that apply) *

FaceBook

FaceBook Messenger

Instagram

SnapChat

Twitter

I am not on social media or do not wish to receive notifications on social media

Required

Please provide your social media name and identify which social media account it is connected with (ex: Instagram; @Bsso).

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