MSSP Alumni - Contact / Information Sheet

General Information

First Name: *required Last Name: *required
Maiden Name (if applicable):

Mailing Address

Street address: *required
City: *required
State: *required Zip Code: *required Home Phone:
Cell Phone:
Work Phone:
Current Employer:
Position: How long in this position?

E-Mail

We have an MSSP Alumni e-mail list serve. We use this e-mail to send out updates, event information, job opportunities, etc. Please check the box next to any e-mail you would like us to include on that list serve.
Personal Email address: Yes, include on list serve
Work Email address: Yes, include on list serve

WOU Information

Year(s) you attended WOU: from to Graduation Term/Year:
Major(s): Minor(s):

MSSP Information:

Please check all that you participated in:

Other:

Personal Information:

Married? Yes No
Children? Yes No Spouse's/Partner's Name:
Child(ren)'s Name(s):

Contact

Multicultural Student Services 503-838-8737 | or e-mail: mssp@wou.edu

sandman-127 Remote IP: (none!)

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WOU: MSSP Alumni Contact / Information Sheet

Multicultural Student Services & Programs