Alumni Association Database Form

Contact Information

Current Home Address: Phone Number: (xxx-xxx-xxxx)

Email: I want to receive Northside updates via email.

Family Information

Spouse's Name: Number of Children:

Please give us a brief family update:

Educational Information

College Attended: Graduation Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Major/Minor:

Graduate School: Graduation Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Area of Study: Degree (MA, PhD, JD, etc.):

Please tell us about any special academic honors or awards your received in college/grad school:

Please list college/graduate activities and any leadership positions held:

Church Information

Home Church:

Church Leadership Positions:

Other Church Involvement (Sunday school teacher, nursery worker, etc):

Ministries or Outreach Programs in which you participate:

Job Information

Place of Employment: Job Title:

Job Description:

Please tell us about any awards and recognitions you have received:

Please list and briefly explain any additional activities and leadership positions held:

Please use the space below to tell us any additional information about yourself and your family

Please check to allow us to post this information on Northside's website.