Getting to Know You…Again!
Stevens Cooperative School Alumni Data Sheet

Please take a few minutes to tell us about yourself and your family. You may simply ignore the questions that don't apply to you.

Personal Data

Name:

If different, your name when you were at Stevens:

Your mailing address:

Your fax #:


Your home phone #:

Your cell phone #:

Your place of work:

Your work phone #:

Your work address:

How long have you worked there?

If less than a year, where did you work before? (Please include all places you have worked during the past 5 years.)

Your occupation:

How did you get into this line of work?

Hobbies:

Single Married Separated Divorced Living w/ Significant Other

Do you have children? Yes No

If yes, please list names & ages:


If yes, where do they go to school?

Do you have pets? Yes No

If yes, please list kind of pet and names:

Your Years at Stevens

Date of Birth:

What year did you enroll at Stevens?
How old were you? What grade did you enter?
What year did you leave? How old were you? What grade?

If you left before completing the highest grade (4th, 5th, or 6th), why did you leave?

Your Continuing Education
Please include city & state following school names

Where did you go to school next?

Where did you go to High School?

College or Other Post-Secondary Training?

Graduate Work?

Post-Graduate Work?

What diplomas/degrees do you hold? (please check all that apply):
High School Diploma GED Associates Bachelors Masters Ph.D. Other

Do you make annual contributions to any of the schools listed above?
Yes No

If yes, which ones?

About You and Stevens

Favorite Stevens memory:

Favorite trip while at Stevens:

Favorite thing you built with blocks:

Favorite thing you made in art:

Favorite book you read:

Friends from Stevens you're still in touch with:

Teachers from Stevens you'd like to hear from:

Things you would like to read about in Connections (Alumni newsletter):

Anything you would like us to print about you in the Alumni News section of Connections?

Any questions for Zoë Hauser, the Head of School?

Thank You.