Alumni Survey

Please provide the following contact information:

First Name

Last Name

Middle Name/Initial

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Home Phone

Name while attending Reynolds (if different than above):

First Name

Last Name

Middle Name/Initial

Current occupation and employer:

Title/Occupation

Employer

Work Phone

E-mail

Reynolds Year of Graduation:

Years Attended Reynolds:

Degree/Certificate & Major:

Transfer Institution (if applicable):

List any additional degrees you have received:

I am interested in participating in a formal alumni association:

Yes
No

I am interested in the following alumni activities (check all that apply):

The following membership benefits are important to me (check all that apply):

Alumni Hall of Fame	Membership discounts (ex: Bookstore or restaurant discounts)
Opportunity to engage with faculty	Alumni Profiles on the Reynolds Website
Career advising/job placement	Other (list other membership benefits of interest):
Opportunity for continuing education classes	Other (list other membership benefits of interest):

I would prefer the following types of communications from the college (check all that apply):

General college information Faculty information

Alumni peer news Other

I would like to receive these communications via (choose the one that best suits your needs):

US Mail
Email

Please include any alumni news you would like to share (job promotions, travel, etc.):

Social networking	Help raise funds for Reynolds
Career networking	Community Service Projects
Serve as a Reynolds Ambassador	Student recruitment
Write letters of college support to legislators and community leaders	Activities related to my program of study
Career mentorship for Reynolds students	Serving on an Alumni Steering Committee/Board
Alumni Day Activities (How often, choose one of the following):	Other (list other activities of interest below):
Once a year Twice a year

General college information	Faculty information
Alumni peer news	Other