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Contact information

*Last name

*First name

Birth name (if applicable)

Title (e.g. Mr., Mrs., Ms.)

*Middle name

Suffix (e.g. Sr., Jr.)

*Street Address (and apartment number, if applicable)

*City

*State

*Zip code

*Preferred phone (with area code)

Home Cell Other

Date of birth

Graduation year

*Preferred e-mail address

Optional information

Additional personal information

Marital status:

Married
Single
Divorced
Separated
Widowed
Partner

BGSU ID number
Secondary e-mail address

Seasonal address, if different than primary address (winter/summer)

Street address
City
State
Zip code
From (Month/Year)
To (Month/Year)

Employer information

Employer: (company, corporation, school, etc.)
Street address and suite number
City
State
Zip code
Telephone number (with area code)
Matching gift employer? 1
Yes No
Business title or position

1 To determine whether your employer matches gifts to BGSU, please visit this page

Degree information

Bachelor degree
Year granted
Major field of study
School (BGSU, OSU, etc.)
Master degree
Year granted
Major field of study
School (BGSU, OSU, etc.)
Doctoral degree
Year granted
Major field of study
School (BGSU, OSU, etc.)
Credentials/certificate
Year granted
Major field of study
School (BGSU, OSU, etc.)

Spouse information

First & middle name
Last name
Date of birth
ID number (If BGSU grad)
Bachelor degree
Year granted
Major field of study
School (BGSU, OSU, etc.)
Master degree
Year granted
Major field of study
School (BGSU, OSU, etc.)
Doctoral degree
Year granted
Major field of study
School (BGSU, OSU, etc.)
Employer: (company, corporation, school, etc.)
Street address and suite number
City
State
Zip code
Business title or position
Preferred email address
Telephone number (with area code)
Matching gift employer?
Yes No

Deceased information

Name
Graduation Year
Date of Death

Student Activities and Awards

Greek letters:
Full name of fraternity / sorority:
Awards:
Honor societies:
Letter winner in:
Organizations:
Scholarships received:

Have you ever attended BGSU Firelands?

Yes No

If yes, what year(s)?