Personal Information

	First Name*

	Middle Name

	Last Name*

	Suffix

	Full name while attending UNCW if different from above

	Date of birth*
	mm/dd/yyyy

	Email *

	Home address*

	Address Line 2

	City*

	State*
	--Please Select--ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

	Zip Code*

	Country

	Preferred Phone ex: 123-456-7890

	Phone Type
	--None--HomeCellWork

	Secondary Phone ex: 123-456-7890

	Secondary Phone Type
	--None--HomeCellWork

	Degree Information

	What year did you graduate from UNCW? If you received multiple degrees, please indicate the first received. If you did not receive your degree from UNCW, please indicate the last year of attendance.
	--None--Did not graduate from UNCW19491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010

	Degree
	--None--Bachelor of ArtsBachelor of Fine ArtsBachelor of MusicBachelor of ScienceBachelor of Social WorkCertificate ProgramDoctor of EducationDoctor of PhilosophyMaster of ArtsMaster of Arts in TeachingMaster of Business AdministrationMaster of EducationMaster of Fine ArtsMaster of Public AdministrationMaster of School AdministrationMaster of ScienceMaster of Science in AccountancyMaster of Science in NursingMaster of Social WorkUndecided

	Degree Program
	--None--AnthropologyApplied GerontologyArt HistoryAthletic TrainingBiologyBusiness AdministrationChemistryClinical ResearchCommunication StudiesCommunity HealthComputer ScienceComputer Science and Information SystemsCriminal JusticeCriminology and Public SociologyCreative WritingCurriculum/Instruction SupervisionEducation of Young ChildrenEducational Leadership and AdministrationElementary EducationEnglishEnvironmental SciencesEnvironmental StudiesFamily Nurse PractitionerFilm StudiesFrenchGeographyGeologyGerman StudiesHistoryInstructional TechnologyLanguage and Literacy EducationLiberal StudiesMarine BiologyMarine ScienceMathematicsMiddle Grades EducationMusicMusic EducationMusic PerformanceNurse EducatorNursingParks and Recreation ManagementPhilosophy and ReligionPhysical Education and HealthPhysicsPolitical SciencePsychologyScienceSecondary EducationSocial StudiesSocial WorkSociologySpanishSpecial EducationStatisticsStudio ArtTheatreTheraputic RecreationUndecided

	Do you hold another degree from UNCW? Please indicate the year you completed your second degree.
	--None--194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102010

	Additional UNCW Degree
	--None--Bachelor of ArtsBachelor of Fine ArtsBachelor of MusicBachelor of ScienceBachelor of Social WorkCertificate ProgramDoctor of EducationDoctor of PhilosophyMaster of ArtsMaster of Arts in TeachingMaster of Business AdministrationMaster of EducationMaster of Fine ArtsMaster of Public AdministrationMaster of School AdministrationMaster of ScienceMaster of Science in AccountancyMaster of Science in NursingMaster of Social Work

	Additional Degree Program
	--None--AnthropologyApplied GerontologyArt HistoryAthletic TrainingBiologyBusiness AdministrationChemistryClinical ResearchCommunication StudiesCommunity HealthComputer ScienceComputer Science and Information SystemsCriminal JusticeCriminology and Public SociologyCreative WritingCurriculum/Instruction SupervisionEducation of Young ChildrenEducational Leadership and AdministrationElementary EducationEnglishEnvironmental SciencesEnvironmental StudiesFamily Nurse PractitionerFilm StudiesFrenchGeographyGeologyGerman StudiesHistoryInstructional TechnologyLanguage and Literacy EducationLiberal StudiesMarine BiologyMarine ScienceMathematicsMiddle Grades EducationMusicMusic EducationMusic PerformanceNurse EducatorNursingParks and Recreation ManagementPhilosophy and ReligionPhysical Education and HealthPhysicsPolitical SciencePsychologyScienceSecondary EducationSocial StudiesSocial WorkSociologySpanishSpecial EducationStatisticsStudio ArtTheatreTheraputic Recreation

	Activities at UNCW
	Please list sports, clubs, greek organizations and UNCW employment here.

	Employment Information

	Job Title

	Employer

	Work Email

	Company address

	Address Line 2

	City

	State
	--None--ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

	Zip Code

	Country

	Work Phone ex: 123-456-7890

	Family Information

	Marital Status
	--None--SingleMarriedDivorcedWidowed

	Spouse Name

	Marriage Date
	mm/dd/yyyy

	Is your spouse a UNCW Graduate?
	YesNo

	Children
	Name   Birth Date   Please indicate if current UNCW student or alumna/us -       -       -       -

	Additional Information

	Please check all that apply
	I would like to be involved with a regional alumni chapter in my area    I would like to be involved with alumni reunions    I would like information on alumni school and club affinity groups (Cameron School of Business, Communcation Studies, School of Nursing, Watson School of Education, African American Graduate Association, Crew Club, SGA, etc.)    I would like more information about UNCW Athletics    Other, please specify

	Do you have anything you would like to add to the Class Notes section of the next UNCW magazine?