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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.)

*Graduation year

*Street Address (and apartment number, if applicable)

*City

*State

*Zip code +4

Telephone number (with area code)
Home
Cell
Other
Marital status
Married
Single
Divorced
Separated
Widowed
Partner
BGSU PIN number

*Date of birth

Preferred e-mail address


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

Street Address

City

State

Zip Code +4

From (Month/Year)

To (Month/Year)


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?1

Yes No

Business title or position

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

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


Parent information

Mother’s Name and Address

BGSU Graduate?
Yes No

Father’s Name and Address

BGSU Graduate?
Yes No

Spouse information

First & Middle Name

Last Name

Date of Birth

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 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

Fraternity or sorority

Greek Letters:

Fraternity/Sorority Full Name:

Recognition

Awards:

Honor Societies:

Letterwinner in:

Organizations (Student or Professional):

Scholarships Received:

Have you ever attended BGSU Firelands? Yes No      If yes, what year?

Would you like additional information on the following programs?

BGSU Alumni Chapter in your area Yes No
Student Recruitment Yes No
Alumni Association Events Yes No
Homecoming Yes No

 

 
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