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Last name:
First name:
Middle name:
Suffix (Jr., etc.)
Maiden/Name when you attended:
Nickname:
Preferred Prefix:
Grad year/last year attended
Name:
*Grad year/last year attended
*Street Address:
*City:
*State:
*Zip:
E-mail
Home Phone

Family Information
Marital Status:
Date of Marriage:
Spouse Name:
Is Spouse an AU alum? Yes No
Children: names and birth dates:

Name of relative who will always have your mailing address:
Relationship:
Is relative an AU alum? Yes No
Street Address:
City:
State:
Zip:
Phone:

Additional Information
Organizations/Activities you have been involved in since college:
Church/Religious affiliation:
Please use this space to send us your latest personal or professional news for the Signatures magazine:
Please release my class note for publication in Signatures magazine.Yes No
Any comments or suggestions? Send them to us here:
IMPORTANT:
The policy of Anderson University is to protect the privacy of University alumni and friends. As a result, your personal contact information will never be sold to other organizations. However, Anderson University occasionally receives requests from alumni who wish to reestablish connections with former faculty and friends. By selecting the ‘Request for Privacy’ option below, you are asking AU to withhold your personal information from fellow alumni wishing to contact you.
Request for Privacy: Withhold personal contact information from inquiring alumni and friends Yes No