Fields marked with an asterisks are required.
 
Personal Information:  
*First Name:
*Last Name:
Please indicate married name or name change:
Year entered University School:
*Year Graduated:
Contact Info:  
*Current Address:
*City:
*State:
*Zip:
*Country:
*Home phone:
Business phone:
Fax number:
*Email:
Additional Info:
 
Is there another permanent address we would keep on file where you can be reached?
 
Please list schools attended and degrees earned since leaving University School.
 
Tell us about your career and positions held since completing your education.
 
Are you willing to speak about your education/career path with students and/or alumni?
Yes No
 
Would you be willing and able to provide internships to students/alumni in your field?
Yes No
 
Please tell us about any civic, community or nonprofit involvement.
 
What's the most interesting or exciting thing you have done since graduation?
 
Can you share any of your classmates’ e-mail addresses?
 
Is there any news you would like to share for our Class Notes section of Viewpoint magazine?
 

Are you interested in reunion information?
Yes No
 
Are you willing to be on a reunion committee?
Yes No
 
Date: