Full Name :

University ID Number:

Address after graduation (Street, City, State, Zip):

Phone Number :

Second phone number :

E-Mail Address :
May we include you in our weekly e-mail distribution list?
Yes No

Date of Birth :

Date you entered Wesleyan?

Did You...
Enter as a freshman? Yes No
Transfer to Wesleyan? Yes No
Take a weekend classes? Yes No
Take evening classes? Yes No

What was your major?
What was your minor?

If graduate student, in which program?
MEd GPNA MBA COU

Do you have a job after graduation? Yes No
If yes, please list employer(s):


Are you planning to attend graduate school? Yes No
If yes, have you been admitted? Yes No
To which graduate program and university have you been accepted?
______________________________________

Spouse's Name:

Did your spouse attend Texas Wesleyan? Yes No
If yes, date spouse attended Wesleyan?

Names of child(ren) and birthday(s)

Did your child(ren) attend Wesleyan?  Yes  No

Did your parents or grandparents attend Wesleyan? Yes No
Names and dates attended:

____________________________________

Did you . . .
Live on campus? Yes No
Participate on an athletic team? Yes No
Participate in a fraternity/sorority? Yes No
Work on the Rambler staff? Yes No
Make the dean's list? Yes No
Graduate with honors? Yes No
Receive an award at Award's Day Yes No
Serve on SGA? Yes No
List any campus organizations or activities in which you participated and offices held.


Church affiliation (i.e. Methodist, etc):

Which congregation?

Community service or organizations in which you belonged:

Honors, awards, publications:

_____________________________________

Would you be interested in serving on any of these alumni committees and activities? (Please check)
Student Recruitment Annual Fund Reunion Committee Career Assistance Alumni Association Homecoming Events

This last item is very important - If we lose contact with you over the years, list two or more relatives who would still know how to contact you (please include name, address, phone #'s & email).