Kinesiology APG - 'Alumni in the Classroom' Application

Personal Information

Title
First Name
Middle Initial
Last Name
Address 1
Address 2
City
State/Province
ZIP
Home Phone
Email Address

Professional Information

Company
Job Title
Address 1
Address 2
City
State/Province
ZIP
Country
Office Phone
Office Fax
Office Email
Brief Job
Description
Brief Company
Description
Company Web site
Best days to
contact you:

Monday

Tuesday

Wednesday

Thursday

Friday

Best time of day
to contact you

Preference

Preferred Contact

Penn State and Other Degrees

Penn State Degree(s) and Year(s)
Alma Mater(s) other than Penn State

Skills, Role, and Work Experience

Skills and areas of expertise
Professional Role
Work Setting

Does your work or another activity bring you to University Park?

University Park?

Would you be able to “visit” the classroom in another format besides a physical visit to campus (via speakerphone, videoconference, computer, visit to your workplace, etc.)?

Other visit?