UChicago OSP-CP Alumni Were you a participant in any of the programs created by Larry Hawkins? The Office of Special Programs-College Prep is forming an Alumni Association! The goals of the Alumni Association will be to engage program participants and encourage them to support the work of the program, to participate in efforts to enhance its sustainability, and to encourage mutually beneficial relationships between the Office of Special Programs-College Prep, alumni, and the parents of alumni and current students. Membership is open to all participants. There are no dues to join. We are in the first phase of forming the Association… gathering information about our alumni to build a directory and form a group of alumni who want to help with encouraging members to share their personal information. We want to identify OSP-CP members who participated in 1968, the first year of the program. With your help we will be successful. This survey will serve as the Alumni Contact Information Form. We ask that you make the completion of this survey a priority as well as to help us to recruit other alumni to do the same. The data we collect from you and your colleagues will help to tell our stories of success and enhance our ability to find additional funding for college preparation programs for middle and high school students. Thank you for your help and please forward this link to others in your network of OSP-CP alumni. Question Title * 1. Contact Information First Name: Last Name: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 2. What is your birthdate: Question Title * 3. Which OSP-CP Program were you a participant of? (Check all that apply) Community College Program CPS College Bridge CPS Prep Program Gear-Up (Price Elementary School) KNABE NYSP (National Youth Sports Program) PEP (Pilot Enrichment Program) Space Explorer (CARA, CFCP, KICP) Special Programs Upward Bound (UB) Upward Bound Math and Science (UBMS) Other (please specify) Question Title * 4. Did you participate in the following activities? (Check all the apply) Adler Intern Leadership Living Book MSI Science Achiever Starlab Program University Theatre Winning Words None of the above Question Title * 5. High School: What high school did you graduate from? What year did you graduate? Question Title * 6. Two-Year Post-Secondary Questions: What college did you attend? What type of degree did you receive (ie..AA, AS)? What year did you receive this degree? What was your concentration? I did not attend a two-year institution. Question Title * 7. Four-year Post-Secondary Questions: What college did you attend? What type of degree did you receive (ie..BA, BS, BFA..)? What year did you receive this degree? What was your concentration? I did not attend four-year post-secondary institution. Question Title * 8. Graduate School Information: (Please list all graduate schools and degrees you received) What institution did you attend? What type of degree did you receive (ie...MA, MS, MBA)? What year did you receive this degree? What was your concentration? I did not attend graduate school. Question Title * 9. Professional School?(Please list all professional schools you have attended) What institution did you attend? What type of degree did you receive (ie..MD, JD, PhD..)? What year did you receive this degree? What was your concentration? I did not attend a Professional School. Question Title * 10. Employer Information:Please respond to the following questions. What is your current job title? Who is your current employer? What is the address of current employer? What is your cell phone number? Question Title * 11. Optional Family Information:Answers to this question are not mandatory. What is your spouse's name? How many children are there in your household? What are their ages? Question Title * 12. Statement of Impact:Participation in the program... Prepared me for college/career Exposed me to diverse cultures and cultural experiences Improved my ability to make oral presentations Provided access to college level courses prior to entering college Helped to improve my academic ability and study habits Improved my time management and test preparation Influenced the way I work in groups Taught me the value of planning and persistence Other (please specify) Question Title * 13. Are you willing to be : interviewed, photographed, and/or videotaped? Yes No Question Title * 14. Do you have experiences you would like to share with us? If so, please use the space below. Question Title * 15. Electronic Signature of the applicant and date. (Type your name in the box below; it will serve as your electronic signature.) Done