Alumni Information Update Form

Alumni Connection Home

	Alumni Information Update Form
	Stay Connected! If you are a CSU Dominguez Hills gradute, please help us keep your contact information current by filling out the form below.

* = Required field

Personal Information

Prefix
First Name*
Middle Name
Last Name*

Please check this box if your name was different while attending CSUDH

Date of Birth *	(MM/DD/YYYY)
Street Address 1 *
Street Address 2
City *
State *	Zip: *
Country
Home Phone	() -
Cell Phone	() -
Email *

Employment Information

Employer
Title
Street Address 1
Street Address 2
City
State	Zip:
Country
Business Phone	() -
Business Fax	() -

Education Information (CSUDH only)

Degree/Credential 1
Major 1
Grad Year 1	(Spring 2009)
Degree/Credential 2
Major 2
Grad Year 2	(Spring 2009)
Degree/Credential 3
Major 3
Grad Year 3	(Spring 2009)
Affiliations (List all - e.g. honor society, athletics, student org., Greek org...)

Family Information

Spouse's First Name
Spouse's Last Name
Is spouse a CSUDH Alum?	Yes No
Number of children

Other Information

What's new in your life?

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