
	Online Directory	Contact Us	Update Your Information	Search

Create Permanent Alumni Record

Please use the space below to create your personal record with the Alumni Association.
* fields are required

*First Name: Middle Name:

*Last Name: Maiden Name:

E-Mail Address (after graduation):

*Student ID #:

Marital Status:
Married Divorced Single Widowed Long-term Relationship

First Name: Middle Name:

Last Name: Maiden Name:

UNI Graduate? Yes No Graduation Year:

Names & Birth Dates:

*Address:

*City: *State: *Zip Code:

Country: *Home Phone:

Notes regarding this address (i.e. Effective 6-1-03 or "only temporary"):

Title:
Employer:

Address:

City: State: Zip Code:

Country: Business Phone:

First Name: Last Name:

Address:

City: State: Zip Code:

Country:

First Name: Last Name:

Address:

City: State: Zip Code:

Country:

(Name and Address of someone who would know how to contact you in case you move in the future.)

First Name: Last Name:

Address:

City: State: Zip Code:

Country:

Relationship (i.e. parent, friend, etc.):

Yes, please send me UNI News, the Alumni Association's bi-monthly
e-newsletter.