ALUMNI REGISTRATION FORM
(Please return to: Alumni-Berlin@dfat.gov.au)

PERSONAL INFORMATION

First name: 		Last name:		
Ms, Mrs, Mr, Dr., Prof., Prof.dr.		Gender	M	F	Australian citizenship?	YES	NO	
Home Phone		Mobile Phone:		
Street Address		
City		Post code:		
Country		
Email address		
Web address		
Australian Institution(s) you attended and years of study 	1.

2.

3.
	
If you won a scholarship for your study, please write details/name of the scholarship and institution.

YOUR FINAL EDUCATION LEVEL

Degree		
Course of study		
Graduation Year		Major:		
Education Institution:		
Thesis topic (if relevant):		
Additional information:	

YOUR WORK EXPERIENCE (for networking purposes, please provide as much work info as you can)

Current Employer Name: 		
Industry: 		
Position: 		
Department: 		Date Commenced:		
Address:		
Business phone:		Mobile:		
Email address:		
Previous Employer Name		
Industry: 		
Position: 		
Department: 		
Dates worked:	From:		To:		
Address:		

YOUR INTERESTS     What are your areas of academic interest from the following list?

Science		Law		Banking & Finance		
Management		Education		Tourism		
Health		History		Humanities/Languages		
Art		Information Technology		Human resources		
Music		Architecture		Archaeology		
Other:		

Please expand on above interests by writing particular fields of interest:		

Privacy policy: The information provided in this questionnaire will not be made available outside the Embassy without your approval. 

If you agree to provide consent for your contact details to be shared amongst the alumni network please type your name and date in this box: