alumniroughdraft | Department of Microbiology and Immunology

First Name

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Last Name

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Program

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Year Admitted

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Year Graduated

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Email

Must be a valid email address

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Home Address Line 1

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Home Address Line 2

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City

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State

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Zip Code/Postal Code

Must be a number

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Country

if outside the United States

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Phone Number

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Did you hold any internships while you were a student in the program?

If applicable, please provide us with the organization’s name and position held

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What are you currently doing?

Please let us know about your current employment status and/or additional education opportunities.

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Would you be interested in serving as a career mentor to an alum or student?

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If you answered “Yes” to the previous question, how would you prefer to be contacted?

I would prefer for an employee of Georgetown University to contact me via email first before my email address is provided to the alum or student
The email address I’ve included with this form can be directly emailed to the alum or student. A Georgetown University employee does not need to contact me first

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