Do you know someone who has an interest in the future and success of the College of Earth and Mineral Sciences? If you would like to share that information with us, please complete the form below. Thank you in advance for your participation in this survey. Your confidentiality is of the utmost importance to us and all names shared during this survey will be kept confidential and will only be viewed by staff in the College of Earth and Mineral Sciences' Development and Alumni Relations Office. Please fill out as much of the form as possible but please do not feel obligated to complete every field. Required fields are indicated with an *. Your Name * Referral Name * Did the referral graduate from the College of Earth and Mineral Sciences at Penn State? Yes No Not Sure No, but the referral would be a valuable industry connection. Referral's Email Referral's Phone Number Referral's Location (eg. city, state, address) Referral's Employment Information (eg. company name, title, industry, etc.) How do you know this person? Classmate at Penn State Classmate at another university Current/former co-worker Industry connection Personal connection Other (Please explain) Do you want this referral to be held in confidence? * Yes No Other...please explain Do you want this referral to be held in confidence? Other...please explain Other Relevant Information Leave this field blank CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Submit
