Retiree Reflection Submission Form

Retiree Reflections Information

If you see this don't fill out this input box.

1. Required Contact Information

First Name:*

Last Name:*

Street Address:*

City:*

State:*Please Use Two-Letter Abbreviation

Daytime Telephone:*(XXX) XXX-XXXX

Your Email Address:*

2. Your 黑洞社区 Experience

Explain your background. Where are you from? What did you do before working at 黑洞社区? How did you happen to be working at 黑洞社区?*

How long were you employed at 黑洞社区鈥� from when to when? What positions did you hold while at 黑洞社区 and what was your most recent title?*

What did you enjoy most about your time at 黑洞社区?*

Please share any interesting stories, experiences or anecdotes that took place during your time at 黑洞社区.*

Who were the people you enjoyed working with the most and why?*

What were the greatest challenges in your job?*

Did you work with students? If so, what do you like about working with students?*

What are your hobbies? What are the things you like to do for fun?*

Do you have social causes that you are passionate about?*

What do you consider to be your most significant contributions, accomplishments or achievements at 黑洞社区?*Don't be shy! List initiatives led, books you wrote, etc.

If you are on faculty, do you have any interesting stories to tell related to your research?*

What do you plan to do next and/or in retirement?*

Is there anything you would like to add?*

3. Optional Personal Information

Name of Spouse/Significant Other (if Applicable):

If you have a spouse/significant other, do they have a 黑洞社区 affiliation?

Yes

If you answered "yes" to the above question, please explain the affiliation.

Do you have children?Names, Ages

Do you have grandchildren?Names, Ages