SW Alumni Information Form

Alumni/Supporters/Friends Survey
Help the College of Social Work keep up with its alumni, supporters and friends Fill out the form below to let the College of Social Work know what you are up to! When you are finished, click on the submit button, and your request will be sent to the College of Social Work by e-mail. If this form fails to work properly, or if your browser does not support forms, please use this link to send a message to the College of Social Work.
Name
Email address
Are you an Alumna/Alumnus of the College of Social Work?	Yes No
Year of Graduation College of Social Work and Degree
Contact Information (I would prefer to be contacted at...)	Street Address
	City, State, Zip
home work	Phone number -	May the College use information about you in the Alumni Newsletter? Yes No

	Ethnicity/Race (Optional)
Please select the one race or ethnicity that applies to you best:
If "Other," please specify:
If American Indian, please specify your tribal affiliation:
If Hispanic/Latino, please specify:	(i.e. Mexican American, Puerto Rican, etc.)
Are you multi-racial or multi-ethnic (parents of one or two of the above groups)? Yes No	If "Yes," please specify:

	Areas of special interest/expertise
Please select all that apply:
If "Other," Please specify:
Name and address of agency/organization you currently work for:
Do you currently work full or part-time?	Full time Part-time

Volunteer Activities (Please select all that apply):

I Would be willing to...

Mentor Current Students

Provide Field Instruction

Serve on the College of Social Work
Advisory Board

Serve on the College of Social Work
Campaign Committee

Serve as a resource or contact person
for recent alumni seeking positions in
my geographical area

Provide the College of Social Work
with job postings from my geographical area

Recruit prospective students through my
contacts with human service organizations
in my area

Speak with admitted students prior to their
enrollment

Participate in a College of Social Work Video for promotional purposes

Additional comments, suggestions, or information:

Click submit to send the form

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College of Social Work main phone number (859) 257-6650
Site Created and maintained by Gary Trumble
Last updated 9-29-09