This form will be used to update the alumni database with current contact information. All information provided will be kept confidential. Statistics will be gleaned from this information and used in a general format to protect privacy. Names only will be utilized in the Alumni Directory section unless permission is given on this form to add contact information. Without updated information, we can not guarantee that you will receive alumni newsletters or notices of special events or recognitions. Please help us keep an accurate picture of our alumni by updating this file on a regular basis. Thank you.
Personal/Contact Information
Last Name:		First Name:
Middle Name:		Maiden Name:
Spouse's Name:		Number of Children:
Home Address:		City:
State:		Zip Code:
Home Phone:		E-mail Address: (required: if no e-mail, use default)
Year Graduated:		Campus:
Degree Earned:		Other Regent Degrees:

Employment Information
Employer:		Your Title:
Work Address:		Work City:
Work State:		Work Zip Code:
Work Phone:		Work E-mail:
Licensure/ Certifications:
Describe your Current Work:
Current Projects:
Family News/ Accomplishments:
Comments

What contact information would you like in addition to your name in the Directory and Business Card sections? Check as many boxes as you want. Home Address Home Phone Number Home E-mail Address Spouse's Name Employer Title Work Address Work Phone Number Work E-mail Address


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Alumni - Update Form