Senior Conservationist Questionnaire  [ARCSE Records-Date Pub.____Age____Memb____]

(If additional space is required, cross reference the number and use the back of this sheet or extra sheets.)

1.    Name_____________________________________ Date of Birth_________ Place________________

2.    Address__________________________City_____________________State_____Zip Code________

3.    University__________________________ Degree(s) and Dates______________________________

4.    Telephone No.________________ Email Address__________________________________________

5.    Marital Status(Spouses Name and dates)________________________________________________

6.    Children: Sons_______ Daughters_______ Grand Children_______ Great Grandchildren__________

7.    Work Experience before SES, SCS, NRCS_______________________________________________

8.    Career Positions (Title, where, and when)________________________________________________

9.    Retirement-Date__________Title_____________________________Location__________________

10.  Honors Received (During and after Career)______________________________________________

11.  After retirement work (What and When)_________________________________________________

12.  Hobbies and Activities______________________________________________________________

13.  Celebrations (Birthdays, Anniversaries, etc.)_____________________________________________

14.  How is your health?________________________________________________________________

15.  Special Experiences, Publications, Volunteer Activities, or anything you want to include.

 

 

 

 

 

 

 

 

 

 

Return Questionnaire to: Marc Safley, Chronicler, 11975 William & Mary Circle, Woodbridge, VA 22192

 

10/31/09