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OFFICE OF ALUMNI RELATIONS
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Personal Information
Name
 
* *
Nickname
 
  mm/dd/yyyy  
  Male Female  
 
   
,   ,
 
 
* 
I am a/an
     (Check all that apply)
* Indicates a required field.

Degree Information
* 
Preferred class (if different from graduation year)
 
 
   * Honors Program Graduate Yes No
Other Degree You Hold from CCU: 
 
* Indicates a required field.


Additional Education Information
 
   
 
   
 
 
 
 

Employment Information
 
 
 
   
,   ,  
   
   
 

Family Information Spouse
 
   
   
 
Yes No
Degree
  yyyy    
   
yyyy  
yyyy  


Name(s) and Date(s) of Birth:

Child 1 Birthdate mm/dd/yyyy CCU year
Child 2 Birthdate mm/dd/yyyy CCU year
Child 3 Birthdate mm/dd/yyyy CCU year

Class Notes



Photo
If you would like to include a photo with your class note on the on-line version of the Alumni Magazine, attach it here. 
(Only jpeg and gif type images allowed with 2MB limit)

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Information gathered on this form will be used to update CCU’s main Alumni database. Permission is being requested for future online community & directory.



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