Name      

Address  

City       State       Zip  

Telephone  

Alternate Telephone  

Email  

Alternate Email    

Are you currently attending or a graduate of a college, university, or vocational school?  yes  no

What college, university or vocational school are you attending or a graduate of?  

If you are a student, what is your major?  

If you are a college / post high school graduate, what was your major, degree or field of study?     

Are you currently employed?   yes   no

If employed, name of employer.  

What grades were you a member of MEPI?      thru  

What do you consider MEPI's impact on your life to be?  

Additional comments  

                                                                         Click "Submit" button to send       

Thank you for taking the time to fill out our survey and good luck in your future endeavors