Name 

Student ID Number (if available)

Undergraduate Degree Earned  

Graduation Year

Graduate School(s) (if applicable)  

Graduate Degrees (if applicable)


Current Mailing Address:
Street and number 

City, State

Zip code


Phone Number

E-mail Address

Employer

Position

May we publish your recent accomplishments on the web page?

Yes No

May we publish your recent accomplishments in an issue of the Honors Community Magazine ?

Yes No

Would you like to receive information regarding Honors College events and news?

Yes No

Are you interested in becoming a member of the Honors College Alumni Council?

Yes No

If you answered yes, please fill in some times that would be good for you to attend a meeting

Please describe your current situation related to employment, a brief description of your work, or anything else you consider significant or would like to share:

Please describe any professional, educational, or personal achievements/accomplishments you would like to share:

If you would like to share any additional information, please do so here:

Please click the submit button below once only.