Please print and fill out and send back to us at :
| Department of Chemistry and Biochemistry |
| Kennesaw State University: MS 1203 |
| 1000 Chastain Rd |
| Kennesaw, GA 30144 |
or email the information to Chris Dockery at cdockery@kennesaw.edu or Heather Govert at hgovert@kennesaw.edu
Please print using blue or black ink:
Name: Name as a student (if different):
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Major: Year graduated:
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Degrees held: School for each degree:
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Full Address: Home Phone Number:
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Email Address (please note which email you would prefer to communicate with the department):
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Profession (please explain your profession related to Chemistry):___________________ ____________________________________________________________________
Name of Company: _____________________________________________________
Work Address: Work Phone Number:
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Work Email Address: ____________________________________________________
Would you be interested and available to speak to our current classes about your profession?
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Would your company be interested in providing an internship to a current KSU student? If so what type of position would it be?
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Do you have any information that you would like to post in our newsletter?
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