Alumni Forum Services for Haas School of Business at UC Berkeley

UC Berkeley Haas School of Business Alumni Forum Member Profile

Thank you for your interest in learning more and possibly joining a Berkeley-Haas Alumni Forum. Please complete this profile to express interest and to help us place you in an appropriate Forum. You will receive additional information before you need to decide whether you definitely want to join.

Note: All information will be kept confidential and used only for the purpose of matching you with an appropriate peer group.

Questions in bold are required.

1. Your name

First Name:

Last Name:

Preferred / Nickname:

To help us match you with a geographically appropriate group, please answer the following questions regarding your location and contact details.

2. Please enter your home address information below.

Home City:

Home State / Province:

Home Country:

Email:

Confirm Email:

Cell Phone:

3. Your current work status
	Working full-time

	Working part-time

	Between jobs / In transition

	Full-time student

	Retired

4. Name of current or most recent company/organization (if self employed, the name or type of business)

5. Please enter your work address information below.
	Same as Home Address:

Work City:

Work State / Province:

Work Country:

Work Phone:

6. Primary Industry

7. Secondary Industry

8. Are you the Founder/Owner?
YES		NO

9. Your title
	CEO/Chairman/President/Managing Director/Managing Partner

	Vice President

	Director

	Manager

	Other, please specify

10. Revenue for the part of the organization for which you are responsible (the entire company if you are the owner or president)

	$0 - 500,000

	$500,001 - 1 million

	$1 - 5 million

	$6 - 25 million

	$26 - 100 million

	$101 million - 1 billion

	$1 billion+

11. Number of employees in the part of the organization for which you are responsible (the entire company if you are the owner or president)

	0 - 10

	11 - 20

	21 - 50

	51 - 100

	101 - 1,000

	1001+

12. LinkedIn Profile

Personal Demographics

13. Which Berkeley-Haas Alumni Chapter are you closest to geographically

14. Which academic program did you complete?

15. What year did you complete the program?

16. Gender
	Male

	Female

17. Year of birth

18. Have you previously been in a Forum? (please describe)

19. Is there any additional information about your personal or professional life that you'd like to share to help us with the sorting process?