BSSA MEMBERSHIP FORM
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* REQUIRED FIELDS

*UCSD STUDENT ID:

*Last Name: *First Name: Middle Initial:

*Current Address: *Street:

*City: *State: *Zip code:

*E-mail: *Phone w/area code:

*Major: Choose one Animal & Neuroscience Biochemistry & Cell Biology Bioinformatics Ecology Behavior Evolution General Human Biology Microbiology Molecular Biology Physiology & Neuroscience *Minor:

*College: Choose one Eleanor Roosevelt (ERC) Marshall Muir Revelle Sixth Warren *Anticipated Year of Graduation:

*Birthdate: mm dd yyyy *Gender: CHOOSE ONE Female Male

*At this time, what do you plan to do after graduating from UCSD (e.g., graduate school, medical school, law school, research, biotechnology, teaching, other):

*Hometown: *Home State:
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Interests Survey
(Though optional, the information requested below will help us to provide
the programs and opportunities of greatest interest and benefit to you. )
Check all that apply.

Volunteer Opportunities
Would like to volunteer as a tutor for students in middle and/or high schools in the area
Would like to volunteer at Children's Hospital
Other volunteer activities of interest (please specify):

Beyond the Classroom (BTC) Program
Would like to help organize a Beyond the Classroom faculty-student luncheon.
Faculty I'd like to talk with at a BTC lunch:
Topics I would like to hear about at a BTC lunch
(e.g., nutrition, cancer research, biotechnology, grad school, etc.):

Mentor Program
Am willing to serve as a mentor for a younger biology student.
Would like to have an older biology student as a mentor.

Beyond the Degree (BTD) Career / Advanced Education Program
Am willing to help organize the biquarterly Beyond the Degree Career Panels.
Careers that I would like to hear about:
Advanced education programs I would like to hear about:

Transfer Student Program
Would like to participate in the monthly Transfer Student activities.
Am willing to mentor a new transfer student.
Would like an older transfer student for a mentor.

Social Activities
Would like to help organize, promote, and set up faculty/alumni/student get-togethers and other social events.
What professors, teachers, or researchers would you like to have invited to a social event?

What other BSSA social events would you participate in? (e.g., zoo trip, bonfire, opera, etc.):
Am willing to help organize the annual Graduating Senior Reception.


Comments
How can BSSA help you to achieve your educational, career, social, and other goals? What programs, activities, events, and opportunities for participation can we provide for you?