Voluntary alumni update form

NOAA Student Scholarship Programs OMB Control #0648-0568

VOLUNTARY ALUMNI INFORMATION UPDATE SHEET Expires: 10-31-2010

Please indicate the Scholarship received:

Graduate Sciences Program EPP Undergraduate Scholarship Hollings Undergraduate Scholarship

Nancy Foster Scholarship Cooperative Science Center Other_______________________

Last Name: __________________ First Name: __________________ Dates in Program: _______________________

Previous name used, if different from above: __________________________________________________________

Phone: _____________________________ E-mail Address: _______________________________________

Additional Degrees Earned Beyond Years in Scholarship Program:

(1) Institution: _____________________________State: __________ Degree: ___________ Grad. Date: __________

Thesis Title: ____________________________________________________________________________________

Major: ___________________________________________ Area of Concentration: _________________________

(2) Institution: _____________________________State: __________ Degree: ___________ Grad. Date: __________

Major: ___________________________________________ Area of Concentration: _________________________

Employer: _____________________Occupation/Title: ________________________Field of Work: ______________

Hired Date: ___________ Industry Sector: _________________________________________________

Most significant achievement since receiving the Scholarship: _____________________________________________

______________________________________________________________________________________________________________________________________

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Please return this form to: Student Scholarship Programs, NOAA Office of Education, 1315 East West Highway, SSMC3, Room 10600, Silver Spring, MD 20910, Voice: (301) 713-9437 x150, Fax: (301) 713-9465, E-mail: [email protected] or Cooperative Science Centers, Meka Laster, Room 10700, Voice: (301) 713-9437 x147, Fax (301) 713-9465, E-mail: [email protected]

PAPERWORK REDUCTION ACT INFORMATION

NOAA administers the Office of Education Scholarship Programs in order to promote the education and training of students in NOAA sciences. The information contained in this application will be used to update information on NOAA scholarship students who have completed a NOAA scholarship program. The information on this form will be treated confidentially. Public reporting burden for this collection of information is estimated to average 1 hour per form including the time for reviewing the instructions and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to NOAA Office of Education, Educational Partnership Program, 1315 East-West Highway, Silver Spring, MD 20910. As needed, student information may be disclosed to the National Oceanic and Atmospheric Administration Office of Civil Rights and the Workforce Management Office to assist the Office of Education in completing and maintaining the student tracker records. The justification for sharing information on a need to know basis within the agency is provided explicitly within the statutory language of the Privacy Act.  See 5 U.S.C. 552a(b)(1).

Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number