Prefix Mr. Mrs. Ms. Dr. Rev.
First Name
Middle Initial
Last Name
Preferred Name
Suffix (Jr., Sr., M.D., etc.)
Maiden Name
Address Line 1
Address Line 2
City
State
Zip Code
Country
Phone Number
Fax Number
Email Address
SWU ID#
Birthday
Gender Male Female
Marital Status Single Married Divorced Widow(er)
Program Type Undergraduate Main Campus Adult Evening EASE Dual Enrollment / Gateway High School Junior College Kernersville Online Student
Adult Evening Cohort
(only if adult evening student)
Graduation Year
Social Class Year
Major
(list all majors)
Men's Soccer
Men's Basketball
Men's Cross Country
Men's Baseball
Men's Golf
Women's Soccer
Women's Basketball
Women's Cross Country
Women's Softball
Women's Volleyball
Women's Golf
(check all that apply)
President
Vice President
Treasurer
Secretary
Ministry Team
(if traveled, list name(s) of teams)
Music Ensemble
Chorus / Choir
Student Chaplain
Drama
Christian Service Organization
Rotaract
Student Alumni Association
Student Missions Fellowship
Yearbook
Sigma Delta / Peer Advisors
Other:
Church Name
Church City
Church State
Church Zip
Religious Affiliation Baptist Catholic Christian Church of God Episcopal Lutheran Nazarene Pentecostal Wesleyan
Spouse's Name
Is spouse an alumnus? Yes No
Spouse Graduation Year
Children Names and Ages
Employer
Matching Gift Company No Yes
Position Title
Business Address Line 1
Business Address Line 2
Business Phone
Business Fax
Business Email
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Photo 1
Photo 1 Description
Photo 2
Photo 2 Description
Photo 3
Photo 3 Description
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