Alumni Information Form

Name________________________________________   Year of Graduation__________
 (First)                    (Maiden)                (Last)                                                                  

Address_______________________           Apt____       H-Phone (___)_____________

City________________ State_______  Zip__________  W-Phone(___)_____________

[  ] Married     [  ] Single     [  ] Divorced     Religious Affiliation___________________

Spouse's Name___________________  E-mail Address__________________________

Grade School you attended_________________________________________________

High School Activities (list)_________________________________________________

Did you attend college [  ] Yes    [  ] No    Major____________  Degree______________

Name of College or University_________________________ Year Graduated_________

If you have children of school age list their names, ages & grade school, high school or college attending:

(Name)                                     (Age)                                   (School)

   _____________________                ____________           ______________________

   _____________________                ____________           ______________________

   _____________________                ____________           ______________________

Employer________________________  Present Occupation ________________________

Address__________________________________ Employer Matching Gift   [  ] Yes [  ] No