Rochester EOC Alumni Information Request

Rochester EOC Alumni Information Request

Congratulations Rochester EOC (REOC) Alumni!

We want to celebrate you and the impact that you've had in the lives of your family, friends, and the community!

We appreciate the efforts that you made toward your successful completion of your program while at REOC. We recognize that you have made incredible contributions in the community since your graduation.

Please complete the following information so that we may capture all of your accomplishments. We want to recognize your efforts toward your career, and what motivated you to be where you are today.

In order to use your story, we need you to complete the Media Release authorization at the end of this form. This Release allows REOC to use your information and story in our publications, website, and any other media-related materials.

If you have any questions, please do not hesitate to contact us at REOCAlumni@brockport.edu

Thank you for your time and we appreciate everything that you have accomplished!

Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Current Phone Number Current Phone Number - ### - ### ####
Alternate Phone Number Alternate Phone Number - ### - ### ####
Alternate Phone Number Contact Information (Name)
Email
Do you have a Facebook account?

Do you have a Facebook account? Yes No
What is your Facebook name?
Program(s) Completed

Program(s) Completed Auto Technician Barbering Building Trades Child Development Associate/Renewal/Spanish College Preparation Cosmetology Culinary Arts Emergency Medical Technician (EMT) Emergency Telecommunications English for Speakers of Other Languages (ESOL) Fiber Optic Technician High School Equivalency Medical Administartive Assistant Nursing Assistant/Refresher Pharmacy Technician Phlebotomy Practical Nursing Pre-Vocational Studies Security Guard Sterile Processing Technician Teacher Assistant Welding Other Other
Graduation Year
Maximum of 4 digits allowed. Currently Entered: 0 digits.
If you graduated from more than one program, please put the year from the most recently graduated program.
Current Employer
Current Position
Did you continue your education after REOC?

Did you continue your education after REOC? Yes No
Degree Or Certifications Received. (Enter n/a if not applicable.)
TELL US YOUR STORY: Part One
Tell us the challenges you had and/or your history that led you to the REOC.

What made you take that step to the REOC?

NOTE: Please be specific in your stories with a minimum of 100 words. The more information we have the better we can tell your story!
TELL US YOUR STORY: Part Two
Tell us about your time at REOC. What were some of the positive experiences that shaped your life and helped you to reach your goal and where you are today?
TELL US YOUR STORY: Part Three
What changed in your life as a result of you attending the REOC?

NOTE: Please be specific in your information. The more information we have the better we can tell your story!
TELL US YOUR STORY: Part Four
Tell us about your professional accomplishments.

NOTE: Please be specific in your response. The more information we have the better we can tell your story!
TELL US YOUR STORY: Part Five
What one quote would you like to give/share with current and future students of the REOC? (No more than 1-2 sentences, please.)
How did you initially find out about REOC?

NOTE: Please be specific in your stories. The more info we have the better we can tell your story!
REOC is always interested in new career-related program ideas. Please list any program suggestions below.
Would you be willing to speak at REOC events?

Would you be willing to speak at REOC events? Yes No
Would you be willing to volunteer at REOC events?

Would you be willing to volunteer at REOC events? Yes No
Are you interested in participating in REOC's Advisory Council?

Are you interested in participating in REOC's Advisory Council? Yes No
NOTE: As part of the Alumni Spotlight Mach form we will also be asking for a headshot to be taken by one of our staff, so please make sure to put a working phone number in your submission for them to reach out and schedule a time to have your photo taken.
Type your name in the box below.

MEDIA RELEASE
I do hereby give Rochester EOC, its assigns, licenses, and legal representatives the irrevocable right to use my name (or any fictional name), picture, portrait, or photograph in all forms and media in all manners, including composite or modified representations, for advertising, trade, or any lawful purposes, and I waive the right to inspect or approve the finished product, including written copy, that may be created in connection herewith. I am of full legal age, and have read this release and am familiar with its contents.

I understand that my printed name is given as the legal representation of my signature.