Technology & Engineering Sciences Alumni Registry Form

Please fill out and return to: Araya Amsalu <AMSALU@ecs.umass.edu>


------------------------------------------------------------------------------
Technology and Engineering Sciences Alumni Registry Form

Name in Full      : _________________________________________
Email Address(es) : _________________________________________

Major and
Degree(s) Obtained: _________________________________________
Date(s) of Grad.  : _________________________________________


Additional Info You Wish to Provide:




May above info be publicly accessible on the web (yes/no) ? :
-----------------------------------------------------------------------