Southeast Missouri State University

Alumni Information Update

Please complete the form below and press "Submit" to update your information. Thank you!

*Personal Information*
First Name		Middle Name
Last Name		Maiden Name

Social Security No.

Date of Birth

Gender

Marital Status

Date of Marriage

Address

City

State

Zip

Phone

Fax

Email

Your Employer Information

Company

Job Title

Address

City

Zip

Phone

Fax

Email

Your Spouse's Information

First Name		Middle Name
Last Name		Maiden Name

Spouse's Southeast Degree Information
Year	Degree	Major

Spouse's Employer Information

Company

Job Title

Address

City

State

Zip

Phone

Fax

Email

Children

Child's Full Name	Date of Birth

Your Southeast Degree Information

Year	Degree	Major

Your Organizational Affiliation at Southeast

Please list the names and addresses of two people from whom your address may

always be obtained.

Name
Address
City
State
Zip
Phone

Name
Address
City
State
Zip
Phone

I would like information on the following:
Alumni Membership	Booster	Endowments	KRCU

Scholarships

Wills/Estate planning

Alumni Activities
Please indicate your interest in assisting and supporting the following programs and activities:

1 = Very interested; 2 = Somewhat interested; 3 = No interest
Alumni Chapters	Alumni Events	Alumni Reunions	Homecoming
Student Recruitment

Alumni Gatherings
I am interested in planning or helping to plan alumni gatherings.
*Comments:*