SHAWNEE STATE UNIVERSITY

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Alumni contact information
Personal Information
First Name:
Middle Initial:
Last Name:
Maiden Name/Former Name:
Date of Birth	Year:
Address:
City:
State:
Zip:
Is this a new address? Yes No
Home Telephone Number:
E-Mail Address:
Graduation Year:
Years Attended(if not graduated):
Major:
Did you participate in SSU athletics? Yes No
If so, which sport?
Other Activities Participated in at SSU
Place of employment:
Position:

Spousal Information
Name of Spouse:
Is your spouse an SSU graduate?	Yes No
Year graduated:
Years attended (if not graduated):
Spouse's Date of Birth:
Spouse's Employer
Spouse's Occupation
Any additional information you'd like to share( marriages, children, etc.)

Would you be interested in serving on a committee of the Alumni Association? Yes No
Would you like your employment and family information published in AlumNotes? Yes No

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This page maintained by Terry Hapney

Shawnee State University
940 Second Street
Portsmouth, Ohio 45662-4344
To_SSU@shawnee.edu
740.351.4SSU
TTY: 740.351.3159

Last Updated:
01.31.2008 04:37 PM