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(Please circle or check the appropriate responses and fill in the applicable blanks. Do not sign this form. Please return this form to Joseph Cahn, 20 Ocean Park Blvd., Unit #9, Santa Monica, CA 90405, in an envelope without a return address.)
1. GENDER: Male Female 2. AGE ___________________ 3. GEOGRAPHICAL DATA (a) Country of Origin____________________________________________ (b) Country of Residence________________________________________ (c) State or Province of Residence________________________________ 4. MIT UNDERGRADUATE DEPARTMENT _______________________________________________ 5. GRADUATE DEGREE(S)with Schools _________________________________________________ 6. MILITARY SERVICE Yes No Branch _____________________________________________ Dates ____________________________Highest Rank __________________________
7. CAREER (A) I am: (1) Working: full time part time (2) Working in my original career field, which is________________________________ (3) Working in a new career field, to wit:____________________________________ __ 4) Retired (B) I work (worked) principally in the following industries: Agribusiness Education Telecommunications Government Military Medicine/Healthcare Media Architecture/Construction The Arts Manufacturing Extractive industry Service Industry Information Technology Transportation Consulting Politics Law Financial Services Sports Other ________________________________________________________________________________ (C) My principal functions are (were): Manage/Executive Physician Manufacturer Marketer/Sales Scientist Architect/Planner Lawyer Finance/Accountant Teacher Engineer – Design Consultant Administrator Human Resources Engineer - Test Engineer - Service Other _________________________________________________________________________________ (D) In the most significant part of my career, I have been (was)employed: By an established organization By an organization I founded (or helped to found) Self-employed Other ______________________________________________________________ (E) After graduation, I have been (was) employed by ______________ different organizations. (F) I have made _________________ fundamental career changes since graduation. (G) On a scale of 1 - 5 (1=not at all, 5 = greatly), how has your career met your expectations? _______ (H) On a scale of 1 - 5 (1=not at all, 5 = greatly), how much did your MIT experience influence your career? ______
8. OTHER ACHIEVEMENTS (A) Number of articles/papers published: 0____ 1-5____ 6-10____ 11-15____ 16-25____ 26-50____ >50____ (B) Number of books published: 0___ 1___ 2___ 3___ 4___ 5___ >5____ (C) Number of patents issued: 0___ 1-5___ 6-10___ 10-20___ >20_____ (D) Number of memberships on corporate boards: 0___ 1___ 2 ___ 3____ >3____ (E) Number of memberships on non-profit boards: 0___ 1___ 2___ 3____ >3___ (F) Number of honors and/or prizes: 0___ 1___ 2___ 3___ 4___ 5___ >5___ (G) Number of elected or appointed positions in local, state or federal government?_____________ Titles/Offices_____________________________________________________________
9. PERSONAL (A) My current residence is: Owned house Rented house Owned condo Rented condo Apartment Retirement community Other(what?)___________________________
(B) My current status is (check all that apply): Single Married Divorced Widow(er) Separated Committed relationship (other sex) Committed relationship (same sex) (C) Please fill in the blanks: Years married to current spouse: <10___ 10-15 ___ 16-20___ 21-30___ 31-40___ 41-45___ 46-50____ >50______ If >50, how many?_____ Times married_____ Times divorced______ Times widowed_______ No. Of children_____ Children at home______ Children at college____ Children at MIT (ever)______ Children graduated from college______ Children currently married______ Children currently Divorced or Separated____________ Age of youngest child_____ Age of oldest child______ Grandchildren_______ Age of oldest grandchild______ (D) On a scale of 1 - 5 (1=very poor, 5 = excellent), how would you rate your health?___________ (E) On a scale of 1 - 5 (1=very poor, 5 = excellent), how would you rate your fitness? __________ (F) On a scale of 1 - 5 (On a scale of 1 - 5 (1=very poor, 5 = excellent), how would you rate your mental acuity?_______ (G) On a scale of 1 - 5 (1=very dissatisfied, 5 =extremely satisfied), how would you rate your satisfaction with your life?___________ _ (H) If you had it to do all over again, would you choose a different....? College Course Career Spouse Gender Sexual orientation Country Region Life Would Not Change a Thing (I) Circle all the sports activities you pursue actively: Spectator sports (Which ones?)______________________________________________________________ Individual competitive sports (Which ones?_____________________________________________________ Individual non-competitive sports (Circle all those applicable): Fitness exercise Golf Fishing Downhill skiing Cross-country skiing Gardening Scuba diving Snorkeling Flying Walking Sailing Boating Bicycling Canoeing Windsurfing Surfing Bodyboarding Other_____________________________________________________________________
(J) Circle all the hobbies that you pursue actively: Painting Writing Composing Photography Stamp collecting Antique collecting Art collecting Coin Collecting Other collecting_________________________ Carpentry Home Repairs Weaving Jewelry Other Craft_____________________ Hospital Volunteer Senior Citizen Aide Fire/Police Volunteer School Volunteer Other Volunteer______________________ Music listening Preferred Kind of Music___________________ Theater Dance Music Other Performing Arts____________________ Reading Cooking Model railroading Model boats Model cars Computers Foreign travel Domestic travel Socializing Theater attendance Cinema attendance Hiking Camping Rock-climbing Radio/Hi-Fi TV Surfing Religious Activities Genealogy Bridge Other___________________________________________________________________________
(K ) What do you believe? Please place a check mark in the appropriate column after each belief:
10. COMPUTER UTILIZATION (A) I have _______home computers: It is (they are): DOS/Windows Mac Other (B) I use it (them) for: Personal Business Not much (C) I/We have internet access by: Dial-Up Cable DSL (D) E-mail usage: Rarely Moderately A lot (E) Internet usage: Rarely Moderately A lot (F) I spend approximately _______ hours per week using my computer of which ________ is on the Internet. (G) I have purchased items over the Internet: None A Few More than a few Many (F) I have my own (or operate someone else’s) website: Yes No
11. FINANCIAL (A) My current net worth is approximately: <$100K___ $100K-$500K___ $500K-$1.0M___ $1M-$5M___ $5M-$10M___ >$10M___ (B) My current income (if still working) is: <$25K___ $25K-$50K___ $50K-$75K___ $75K-$100K___ $100K-$150K___ $150K-$250K___ $ 250K-$500K___ >$500K___ (C)Retirement Funding (Check all that apply ): Corporate pension____ Government pension____ 401-K/403-B____ Social security_____ Private savings_____ Other___________________ (D) My annual retirement income (if retired) is: <$25,000___ $25K-$50K___ $50K-$75K___ $75K-$100K ___ $100K-$125K___ $125K-$150K___ $150K-$300K____ $300K-1.0M_____ >1.0M______
Thank you for contributing to the Class of 1953 questionnaire. |