Dr. Carreon Scholar Survey

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1. The Reynaldo J. Carreón M.D. Foundation is conducting a survey to collect and update your current information in our files. The Foundation has been in existence for nearly 20 years and throughout this time, it has provided scholarships in excess of $1 million to former/current recipients such as you. The Foundation is interested in finding out what you are currently doing and to get reacquainted with you.
The information collected will be used for our own record-keeping needs and to help us in the future, such as applying for additional funding to be able to help more students in the Coachella Valley. We also would like to find out if there are past/current recipients who are interested in helping out and sharing their talents. The Foundation has many plans for the future and we hope you will be interested in assisting in the growth of the Foundation. Please keep in touch with us on Twitter and Facebook: Dr. Carreon Foundation. Thank you so much for taking the time to complete this survey!

The Reynaldo J. Carreón M.D. Foundation is conducting a survey to collect and update your current information in our files. The Foundation has been in existence for nearly 20 years and throughout this time, it has provided scholarships in excess of $1 million to former/current recipients such as you. The Foundation is interested in finding out what you are currently doing and to get reacquainted with you. The information collected will be used for our own record-keeping needs and to help us in the future, such as applying for additional funding to be able to help more students in the Coachella Valley. We also would like to find out if there are past/current recipients who are interested in helping out and sharing their talents. The Foundation has many plans for the future and we hope you will be interested in assisting in the growth of the Foundation. Please keep in touch with us on Twitter and Facebook: Dr. Carreon Foundation. Thank you so much for taking the time to complete this survey! Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Country:
Email Address:
Phone Number:

2. What is your cell phone number?

What is your cell phone number?

3. What is the best way to contact you?

	Best Way to be Contacted:
Best way to be contacted:	What is the best way to contact you? Best way to be contacted: Best Way to be Contacted:

Other (please specify)

4. What year did you receive the Dr. Carreon Scholarship?

	Year
Year	What year did you receive the Dr. Carreon Scholarship? Year Year

5. What high school did you attend?

What high school did you attend? High School Attended:
Year Completed:

6. Which college(s) did you attend?

Which college(s) did you attend? College Attended for Undergraduate Studies (Include state):
Undergraduate Degree Obtained:
Year Completed:
University Attended for Graduate Studies (Include state):
Graduate Degree Obtained:
Year Completed:

7. What is your current occupation?

What is your current occupation? Current Occupation:
Current Employer:
Work Address:
Work Phone:
Work Email Address:
Occupation 2:
Employer 2:
Work 2 Address:
Work 2 Phone:
Work 2 Email Address:

8. Are you willing to volunteer?

Are you willing to volunteer? Yes

No

9. If yes, how?

	Volunteer
Volunteer	If yes, how? Volunteer Volunteer

Other (please specify)

10. Is there anything you would like us to know about you? Have you received any special awards or honors? How did receiving the Reynaldo J. Carreon M.D. Foundation Scholarship impact your college experience?

Is there anything you would like us to know about you? Have you received any special awards or honors? How did receiving the Reynaldo J. Carreon M.D. Foundation Scholarship impact your college experience?

Dr. Carreon Scholar Survey
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1. Default Section

2. What is your cell phone number?

3. What is the best way to contact you?

4. What year did you receive the Dr. Carreon Scholarship?

5. What high school did you attend?

6. Which college(s) did you attend?

7. What is your current occupation?

8. Are you willing to volunteer?

9. If yes, how?

10. Is there anything you would like us to know about you? Have you received any special awards or honors? How did receiving the Reynaldo J. Carreon M.D. Foundation Scholarship impact your college experience?

Dr. Carreon Scholar SurveyExit this survey

1. Default Section

2. What is your cell phone number?

3. What is the best way to contact you?

4. What year did you receive the Dr. Carreon Scholarship?

5. What high school did you attend?

6. Which college(s) did you attend?

7. What is your current occupation?

8. Are you willing to volunteer?

9. If yes, how?

10. Is there anything you would like us to know about you? Have you received any special awards or honors? How did receiving the Reynaldo J. Carreon M.D. Foundation Scholarship impact your college experience?

Dr. Carreon Scholar Survey
Exit this survey