Roosevelt University - Alumni Address Update Form

Alumni Address Update Form
Alumni

Personal Information
First name
Middle initial
Last name
Gender
Marital status
Nickname or preferred first name
Maiden name
Date of birth
Class year & degree (or last year you attended Roosevelt University)

Home Address
Previous street address
Street address
Apartment #
City
State
Postal code
Country
Home phone
Home page
E-mail address

Company Information
Company name
Is this a Matching Gift company?
Your job title
Business street address
City
State
Postal code
Country
Business phone
Business e-mail
Business website address

I prefer to receive correspondence through my address.

Education
Please list all higher education received after you attended Roosevelt.
College	Year	Degree	Field of Study




Family Information
If your spouse also attended Roosevelt, please have him or her fill out a separate form for our records. However, please continue providing the information requested below so that we may keep our records properly connected.
Spouse's first name
Spouse's middle initial
Spouse's last name
Spouse's nickname or preferred first name
Maiden name
Gender
If a former Roosevelt student: Class Year or last year attended
Degree
Major

Children:

Name	Birth date	RU Alum?
Name	Birth date	RU Alum?
Name	Birth date	RU Alum?
Name	Birth date	RU Alum?

Your Comments

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ROOSEVELT UNIVERSITY
OFFICE OF ALUMNI RELATIONS
430 S. Michigan Ave.
Chicago, Ill 60605-1394
312-341-3624. Fax: 312-341-6490
E-mail: alum@roosevelt.edu

Alumni