ALUMNI RELATIONS

Personal Information

Salutation Please Choose: Mr. Mrs. Ms. Miss Dr.

First Name Last Name

Address

City/State/Zip

E-Mail

Home Phone

Ethnicity Gender Select One Male Female

Academic Information

Undergraduate School (Case) Please Choose: Adelbert Architecture Arts & Sciences Case Institute of Technology Cleveland College Education Engineering Flora Stone Mather Library Science Management Nursing Pharmacy Western Reserve College None Graduation Date (MM/YY)

Undergraduate School (other than Case) Graduation Date (MM/YY)

Undergraduate Major Undergraduate Degree

Undergraduate Minor

Undergraduate Activities/Organizations
List activities here.

Graduate School (Case) Please Choose: Applied Social Science Architecture Case Institute of Technology Cleveland College Dental Education Engineering Graduate Studies Law Library Science Management Medicine Nursing Pharmacy None Graduation Date (MM/YY)

Graduate School (other than Case) Graduation Date (MM/YY)

Graduate Major Graduate Degree

I am currently involved in the following alumni activities:
List activities here.

Professional Experience

(Choose at least one)

Current Status: Student Employed Unemployed Retired

If Employed, Current Company

Company Address

City/State/Zip

Work Phone Industry

Job Function/Title Start Date (MM/YY)

I am also interested in being a volunteer in the area(s) of:

(Choose at least one.)

Admissions & Recruitment

Career Assistance

Associations and Schools

Other opportunities in support of students as they become available

At this time I am only interested in Alumni Events

Preferred Contact Method

(Choose one and be sure you have provided that information above.)

Email Home Address

Work Phone Home Phone

Work Address

Please enter any comments or questions here.

For more information, please contact Laura Stauffer at laura.stauffer@case.edu.