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*Last name
Maiden name (if applicable)
*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)
*Date of birth
*Preferred e-mail address
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Seasonal address, if different than primary address (winter/summer)
Street address
City
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Zip code (+4)
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To (Month/Year)
Your employer
Employer: (company, corporation, school, etc.)
Street address and suite number
Telephone number (with area code)
Fax number(with area code)
Matching giftemployer?Yes No
Business title or position
1To determine whether your employer matches gifts to BGSU, please visit this page.Your degrees
Bachelor degree
Year granted
Major field of study
School (e.g. BGSU, OSU, etc.)
Master degree
Doctoral degree
Credentials or certificate
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
Spouse information
First & middle name
Last name
Date of birth
PIN number (If BGSU grad)
Spouse business information
Preferred email address
Matching gift employer?Yes No
Fraternity or sorority
Greek letters:
Full name of fraternity / sorority:
Recognition
Awards:
Honor societies:
Letter winner in:
Organizations (student or professional):
Scholarships received:
Have you ever attended BGSU Firelands? Yes No If yes, what year(s)?