Future Alumni Information Submission Form

 

Please provide the following contact information to be entered into the Henderson State University Alumni Database.  
Use the Tab Key to move from item to item.
 

 

Name: 
Last First  

Middle Maiden Name  

Preferred Name (If different)  

Social Security Number        
Permanent Address: (an address you can receive mail from us)
Street
City State Zip Code
County:
Telephone Number (with area code)

E Mail Address (other than Henderson's)   

Birth Date (Month/Day/Year):    // 

Gender:

  
From which high school did you graduate?
City State What year did you graduate?  
When do you graduate? Month. /Yr.

Major Degree I attended from to  

Activities while attending Henderson (please select all that apply by pressing Ctrl while selecting with mouse): 
Sports 
 

Other (specify):
 
Greeks 
 

Other (specify):
 
Other 
 

Other (specify):
 
Did you receive any scholarships? If so, which one:  
Spouse's Name:             Maiden Name:
Is spouse a Henderson graduate or attended HSU? Yes No

If yes:
My spouse graduated from Henderson in            Major           Degree
If not a graduate, years attended:                   Social Security Number
From which high school did he/she graduate?
School: City: State:
 

Spouse's activities while attending Henderson (please select all that apply by pressing Ctrl while selecting with mouse):
Sports

Other (specify):
 
Greeks

Other (specify):
 

Other

 
Other (specify):
 

Children (Names and Birth Dates):
 
 I am interested in serving on the Alumni Board:

  

 

 

 

Do you want information about you released in the REDDIE REPORT? (i.e. promotions, engagements, weddings, births, deaths)?    

 

 
 
 
 
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