BGSU:Networking


	Networking

New Grad Information Form

In order to guarantee you receive the benefits of your alumni status ~ BGSU Magazine, invitations to alumni events & mailings about services now available to you ~ please take a moment to complete the following information.

* Indicates required field

Your Information

*Last Name

Maiden Name

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

*First Name

*Middle Name

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

*Class of (Year)

*Street Address and Apartment Number if applicable

*City

*State

*Zip Code +4

Telephone Number(with area code)
Home
Work
Cell

Marital Status
Married
Single
Divorced
Separated
Widowed

*BGSU PIN Number

*Date of Birth

*Preferred Email Address

Your Employer

Employer: (Company, Corporation, School, etc.)
Street Address and Suite Number
City	State	Zip Code +4
Telephone Number(with area code)	Fax Number(with area code)	Matching Gift Employer? Yes No
Business Title or Position

Your Degrees

Bachelors Degree	Year Granted	Major Field of Study	School (e.g. BGSU, OSU, etc.)
Masters Degree	Year Granted	Major Field of Study	School (e.g. BGSU, OSU, etc.)
Ph. D.	Year Granted	Major Field of Study	School (e.g. BGSU, OSU, etc.)
Credentials or Certificate	Year Granted	Major Field of Study	School (e.g. BGSU, OSU, etc.)

Contact Person

Name & address of someone who will most likely know your address at all times
(Other than Spouse or Parents)

Relationship

Parents’ Information

Mother’s Name and Address	BGSU Graduate? Yes No
Father’s Name and Address	BGSU Graduate? Yes No

Spouse’s Information

First & Middle Name	Last Name	Date of Birth(If BGSU Grad)	PIN Number(If BGSU Grad)
Bachelors Degree	Year Granted	Major Field of Study	School (e.g. BGSU, OSU, etc.)
Masters Degree	Year Granted	Major Field of Study	School (e.g. BGSU, OSU, etc.)
Ph. D.	Year Granted	Major Field of Study	School (e.g. BGSU, OSU, etc.)

Spouse’s Business Information

Employer: (Company, Corporation, School, etc.)
Street Address and Suite Number
City	State	Zip Code +4
Business Title or Position	Preferred Email Address
Telephone Number(with area code)	Matching Gift Employer? Yes No