usa.gif (956 bytes)Alumni Office Information Request Form

Tell us where you are, and how you are, and what you've been up to.  Fill out the form below, click the SUBMIT button, and 'send' it in.  Use the TAB key to move from one field to the next.  To contact the Radford University Alumni Office, call (540) 831-5248, or toll free by dialing 1-888-4RUGRAD.   The e-mail address is alumnews@radford.edu.

PERSONAL INFORMATION

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone (999) 999-9999
SSN #   999-99-9999
Birthdate    mm/dd/yyyy
Year Graduated
Degree Earned
Major
E-mail
E-mail 2
Personal Web Site

CAREER INFORMATION

Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone (999) 999-9999
FAX (999) 999-9999
Business Web Site

FAMILY INFORMATION

Is your spouse an RU graduate? If so, please list year graduated from RU and major along with his or her name and other pertinent information below:

Spouse's Name
Maiden Name
Year Spouse Graduated
from RU  		  (yyyy)
Major
Children's
Names/Birthdates		 mm/dd/yyyy
mm/dd/yyyy
mm/dd/yyyy

ADDITIONAL DEGREE INFORMATION

Other Degree Received
Name of Institution
Other Degree Received
Name of Institution

TELL US MORE

Use the space below for any other information you'd like to share with us.

 

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Copyright Radford University 1999.
Last revised: April 13, 2004