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Alumni Speakers Bureau

Questionnaire


First Name:
Last Name:
Home Address:
City:
State:
Zip Code:
Home Phone:
Personal Cell:
Personal Email:

Hostos Degree:
Year of Graduation:

Bachelor College Name:
Bachelor Degree:
Year of Graduation:

Master College Name:
Masters Degree:
Year of Graduation:

Doctoral College Name:
Doctoral Degree:
Year of Graduation:

Employer Name:
Job Title:
Work Phone:
Work Email:
Work Cell:
May we contact you at work?

Please specify what your time commitment would be and with what frequency:
Please check all appropriate boxes


Other Frequency:

In what timeframes would you be available to give presentations?
Please check all appropriate boxes



Other Timeframe:

What is your area(s) of expertise?
Please check all appropriate boxes








Other Area of Expertise:
Bio:
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