Converse College Alumnae Information Update

Personal Information

Class Year: *

Converse Degree:

Preferred Class for Reunions:

Prefix preferred: *

Current Full Name: *

Student Name at Converse:

Street Address: *

City: *

State/Province:

Country: *

ZIP/Postal Code: *

Home Telephone:

Cell Phone:

Fax:

E-mail: *

Business Information

Job Title:

Employer:

Street Address:

City:

State/Province:

ZIP/Postal Code:

Fax:

Telephone:

E-Mail:

Family Information

Marital Status:

Spouse Information

Spouse Full Name:

Prefix:

Name called:

Wedding Date:

Spouse Alma Mater:

Spouse Degree:

Year:

Job Title:

Employer:

Children

Child 3

Child’s Name:

Gender:

Date of Birth:

Child 4

Child’s Name:

Gender:

Date of Birth:

Child 2

Child’s Name:

Gender:

Date of Birth:

Child 1

Child’s Name:

Gender:

Date of Birth:

Advanced Degrees

Advanced Degree 3

Advanced Degree:

Month/Year received:

Institution:

Field of study:

Advanced Degree 4

Advanced Degree:

Month/Year received:

Institution:

Field of study:

Advanced Degree 2

Advanced Degree:

Month/Year received:

Institution:

Field of study:

Advanced Degree 1

Advanced Degree:

Month/Year received:

Institution:

Field of study:

Other:

Additional Information:

Recent Life Events:

(death, birth, advanced degree, career change, marital status change)

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Converse College Alumnae Information Update