Innovation and Entrepreurship Network participation survey

WashU Innovators and Entrepreneurs Network Interest Form

*First Name

*Last Name

*City in which you are volunteering:

*Email

Preferred Phone Number

Address Line1

Address Line2

City

State / Province

Zip / Postal Code

Country / Area

WashU Degree and Graduation Year

Are you a WashU Parent?

Yes
No

Current job title(s):

Current company(ies):

What is your primary area of focus or project?

Do you have suggestions for future presentations and networking activities, including web-based exchanges?

Opportunities to become involved in the WashU Innovators and Entrepreneurs Network:

Are you willing to volunteer to organize and help lead future I & E focused events and activities?

Yes
No

Would you be interested in participating as a panelist or keynote speaker for an upcoming event?

Yes
No

Are you able to share internships or employment opportunities?

Yes
No

Would you be willing to meet and talk with current students regarding careers in I & E?

Yes
No

Would you be interested in hosting a smaller (12-15 attendees) networking discussions/educational opportunities on a more specific topic? These would be arranged and funded by the Alumni Association.

Yes
No

Area of expertise/subject of roundtable

Do you have a colleague or fellow alumnus/a you would like to co-host or participate in the roundtable?

Is there a month(s) which would work best to host the roundtable?

Is there certain days of the week and times which would work best with your schedule?

Would you be able to host the roundtable in your office/conference room?

Yes
No

Capacity of office/conference room

Address of office/conference room

Do you have any ideas for other locations to host the roundtable?

Questions or comments?

Thank you for your participation in making the WashU Innovators and Entrepreneurs Network a success! For questions or more information, please contact iandealumninetwork@wustl.edu or (314) 935-5212.