First Name:*		Last Name:*
Company:		Job Title:
E-mail:*		Phone Number:*
Address:
City, State, Zip:

USC Alumni? None Selected Yes No
If yes, Degree: N/A B.S. M.S. Ph.D Major: None Selected Aerospace Engineering Biomedical Engineering Chemical Engineering Civil Engineering Computer Science Computer Engineering & Computer Science Electrical Engineering Environmental Engineering Industrial & Systems Engineering Materials Science Mechanical Engineering Petroleum Engineering Year: None Selected before 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Other Degrees:

I want to be part of: (Check as many as applicable)

Engineering Career Conference
Mentoring or meeting with students one-on-one
Center for Engineering Diversity
Department Initiatives
Student Organization Events -- Organizations:
Workshops -- Topics:

Any comments or questions?