Form – Alumni Information Update Form – Outside of EEA

Name, spouse, and class year

Name*

Include name while attending the University of Rochester if applicable

Spouse/partner's name

Undergraduate or Graduate?*

Undergraduate
Graduate

School(s)*

Eastman Institute for Oral Health
Eastman School of Music
Hajim School of Engineering & Applied Sciences
School of Arts & Sciences
School of Medicine and Dentistry
School of Nursing
Simon Business School
Warner School of Education

Graduation year(s)*

If undergraduate, include year of your graduation. If graduate, include the year you received your master’s, MBA, PhD, MD, DDS, DMD, or other degree.

Majors/minors/program areas

Contact information

Home address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone

Cell phone

Home email*

Reunion

Are you coming back for your reunion?

Yes
Maybe, unsure yet
No

Name while attending ��Թ�

if applicable

Do you want to be involved as a volunteer for your class reunion?

Yes! Please contact me!
No, thank you.

Employment information

Company name

Title

Business address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business phone

Business fax

Business email

Other, please indicate

Field of professional work

as applicable

Student affiliation

If applicable, please share the name of your first-year dorm on the River Campus or at the Eastman School of Music

Other, please indicate

If applicable, please list any special housing you lived in

If applicable, please list sports you were involved in

If applicable, please list clubs/organizations/music ensembles you were involved in

Eastman alumni only: Please list key professors that you worked with outside of your studio professor

Additional information

Do you consider yourself Hispanic or Latino/a/x?

Yes
No

For ��Թ� purposes, to help us better understand the diversity of our community, please select the categories which best describe your racial identity

choose all that apply

Black/African-American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
White
No listed above

Racial identity not listed above, please specify

What is your gender?

choose all that apply

Woman
Man
Trans
Non-binary
Not listed above
Prefer not to answer

Gender identity not listed above, please specify

Do you identify as LGBTQ (lesbian, gay, bisexual, transgender, queer)?

choose all that apply

Yes
No
I'm a LGBTQ ally
I'm the parent of an LGTBQ child
Prefer not to answer

What are your pronouns?

choose all that apply

She/Her/Hers
He/Him/His
They/Them/Their
I use my name as my pronoun
Not listed above
Prefer not to answer

Pronoun not listed above, please specify

Were you a first-generation student (were you the first, or one of the first in your family to attend college)?

Yes
No
Unsure

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Alumni information update form – outside of EEA

Name, spouse, and class year

Contact information

Reunion

Employment information

Student affiliation

Additional information

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