Alumni Questionnaire

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New Record: *

Yes

Title:

First Name: *

Middle Name:

Last Name: *

Suffix:

Maiden Name:

Mailing Address

Street: *

Street (line 2):

City: *

State: *

Zip: *

Personal E-mail:

Work E-mail:

Phone Number:

Program Information

Were you in the undergraduate or graduate program?: *

Undergraduate Program

Major(s) and/or Minor(s):

Graduation Date:

Year:

MPA Modality:

Did you complete the MPA degree on campus or through E-Campus?

Graduate Program

Which MPA concentration were you in?:

Graduation Date:

Year:

Employment Information

What is your current employment status?:

Job Title:

Job Start Date:

Organization Name:

Work Address

City:

State:

Zip:

Job Sector:

Would you like to receive invitations to EKU Department of Government Events by e-mail? :

Yes

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