EIU TRIO SSS Alum Form

Please complete this form as soon as possible to assist us with our EIU TRIO Alumni Association and recognition of your accomplishments.

PERSONAL INFORMATION
Name Name * Title First Last Suffix
Middle Initial
Prior Name(s)
Current Mailing Address Current Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone # Home Phone # - ### - ### ####
Cell Phone # Cell Phone # - ### - ### ####
Email: *
Alternate Email:
TRIO PROGRAM INFORMATION
TRIO Program Participated In:
Years Participated (Attending Academic Calendar Years):
POSTSECONDARY EDUCATION INFORMATION
Bachelor's Degree(s) Earned and Date of Degree(s): *
Minors/ Concentrations:
GRADUATE SCHOOL INFORMATION
Name of Graduate School(s) if Attended:
Master's Degree(s) Earned and Date of Degree(s):
Professional Degree(s) Earned and Date of Degree(s):
CAREER PATH
Current Employer:
Current Employer's City and State:
Current Position/ Dates:
Previous Position(s)/ Dates:

(Include Title, Organization, or Company Name and City)
ACCOMPLISHMENT(S)
Major benefit(s) you received from the TRIO/ Student Support Services. How has TRiO helped you?
Your advice to future TRIO/ Student Support Services Students.
Please share accomplishments and successes.
Are you available for job shadowing/mentoring for current TRIO participants?

*** If so, please complete the mentor application at this link: http://www.eiu.edu/eiutrio/machform/view.php?id=9974

Are you available for job shadowing/mentoring for current TRIO participants?

*** If so, please complete the mentor application at this link: http://www.eiu.edu/eiutrio/machform/view.php?id=9974 Yes, I am Yes I am, as well as, my company offers internship opportunities I could connect a student with No, not at this time No, but I can suggest other opportunities for a student to connect with
Additional Comments, to include honors or awards you have received since you left EIU:
Upload a picture that can be used for our newsletter, web-site, or bulletin board display.
In order to promote the success of our TRIO SSS Alumni, increase our advocacy efforts, expand our mentoring and career information network, and encourage other TRIO eligible students, do you give us permission to share contents of this form to the following TRIO Alumni Associations? Please check all that apply: *

In order to promote the success of our TRIO SSS Alumni, increase our advocacy efforts, expand our mentoring and career information network, and encourage other TRIO eligible students, do you give us permission to share contents of this form to the following TRIO Alumni Associations? Please check all that apply: Illinois TRIO (IL TRIO; our State TRIO Association) Educational Opportynity Association (EOA; our Regional TRIO Association) Council for Opportunity in Education (COE; our National TRIO Association) None of the above

EIU TRIO SSS Alum Form

EIU TRIO SSS Alum Form

PERSONAL INFORMATION

TRIO PROGRAM INFORMATION

POSTSECONDARY EDUCATION INFORMATION

GRADUATE SCHOOL INFORMATION

CAREER PATH

ACCOMPLISHMENT(S)