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Contact information

*Last name		Birth name (if applicable)
Title (e.g. Mr., Mrs., Ms.)	*First name	*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

Marital status Married Single Divorced Separated Widowed Partner	BGSU ID number
Secondary e-mail address

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

First & middle name	Last name	Date of birth	ID number (If BGSU grad)
Bachelor degree	Year granted	Major field of study	School (e.g. BGSU, OSU, etc.)
Master degree	Year granted	Major field of study	School (e.g. BGSU, OSU, etc.)
Doctoral degree	Year granted	Major field of study	School (e.g. 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

Greek letters:

Full name of fraternity / sorority:

Awards:

Honor societies:

Letter winner in:

Organizations:

Scholarships received:

Yes No
If yes, what year(s)?