First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Web Site:
Email Address:
Verify Email:
Home Phone:
Business Phone:
What BSSD school did you graduate from?:
Choose One
Brevig Mission
Diomede
Elim
Gambell
Golovin
Koyuk
Savoonga
Shaktoolik
Shishmaref
St. Michael
Stebbins
Teller
Unalakleet
Wales
White Mountain
What year did you graduate?:
Gender:
Male
Female
Did you have a maiden or prior name? If so it was::
Since leaving high school, which of these have you done?:
Choose One
Entered the work force
Attended a technical school
Attended a 2-year college
Attended a 4-year college
Entered the military
Unemployed
If you entered a college or technical school, which of the following best applies?:
Successfully completed a 2-year, 4-year or certificate program Currently taking classes & plan to graduate No longer taking classes, but plan to return to school within 12 months No longer taking classes& no plans to return to school
List any schools you have attended:
List any certificates or degrees earned & the year:
If you attended college or technical school who supported you and how? What did your family, school and community do?:
Are you currently employed?:
Yes No
If you are employed, with whom? What is your job title?:
What is the most positive experience that BSSD provided you?:
Was there anything that you felt as the BSSD did not provide you?:
Do you have children? If so, how many?:
Do you have any future goals that include further education? If so, what are they?:
Comments: