Please take a moment to fill out this Questionnaire so that we can keep you
informed of the many events that are taking place at Queens College

First Name:

Last Name:

Middle Name:

Maiden Name:

Preferred Title:

SS#:

Class Year:

Address:

Apt.:

City:

State:

Zip:

Home Phone:

Home Fax:

Home E-mail:

Spouse's name:

Is your spouse a Queens College graduate?

Year

 

Professional Information

Your organization's name:

Professional title:

Address:

City:

State:

Zip:

Business Phone:

Business Fax:

Business E-mail:

Occupation:

If you are retired, what was your occupation?

Spouse's organization's name:

Professional title:

Address:

City:

State:

Zip:

Business Phone:

Occupation:

If he/she retired, what was his/her occupation?

 

Education

From Queens College

Date:

Degree:

Major:

Date:

Degree:

Major:

 

Other Degrees:

School:

Date:

Degree:

Major:

School:

 

 

 

 

Date:

Degree:

Major:

 

QC Experience

 

 

Did you belong to a Fraternity/Sorority/Houseplan?

If so, which one?:

Alumni Affairs

I would like to help with:

Planning activities/reunions

Career development

Fundraising

Student recruitment

Comments:

Miscellaneous Information

 

Corporate/Foundation/Community Board affiliations:

Favorite Charities