Oklahoma School of Science and Mathematics
Muskogee Regional Center
2403 N. 41st Street E.
Muskogee, Oklahoma 74403
Alumni Information Sheet
Name:_________________________
Date:__________________________
Address:_______________________
Phone: (home)___________________
(cell)__________________________
E-mail(s):_______________________
Class of ________________________
Check and Fill in the appropriate box(es) below.
Current Status |
School/Academy |
| High School Senior | |
| High School Senior Concurrently Enrolled | |
| College Student (freshman) | |
College Student (sophomore) |
|
| College Student (junior) | |
College Student (senior) |
|
| College Student (Graduate school) | |
Military Academy |
|
Apprentice in Training (put what Field/Area under “School/Academy”) |
|
Work Force (full-time) |
|
Other: |
If you are currently in college,
Academic Major and/or Minor:(major)________________________
(minor)________________________
Scholarships Received to date(list most recent first):
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Awards and Honors Received to date(list most recent first):
__________________________________________________
__________________________________________________
__________________________________________________
Your responses to the following questions may be used as quotes in OSSM
articles and /or promotional material.
How has the OSSM program benefited you?
What advice do you have for current and future OSSM Regional Center student?