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Alumni and Friends: Alumni Directory Entry Form

If you are an alumnus of the Faculty of Applied Health Sciences, we'd love to hear from you and list you in our Alumni Directory. Please fill out the information below and press the submit button. We will try to have your entry added to the database within 48 hours.

Please feel free to omit any information that you do not wish to appear in the directory.

The information provided below is a:

New Entry     Correction to previous entry

Name:

Last Name:
First Name:   As you wish it listed
Other Surname:   Name in University if different

Degrees from Applied Health Sciences:

Bachelor's Degree:

Department:
Type:
Graduating Class of:   Year (eg. 1978)

Master's Degree:

Department:
Graduating Class of:   Year (eg. 1978)

PhD:

Department:
Graduating Class of:   Year (eg. 1978)

Mailing Address:

For your privacy: Street, Phone, and Postal Code will not show in the directory. They will only be used to update Alumni records.

Street:
City:
Province/State:
Country:   other than Canada
Postal/Zip Code:   
Phone:   (eg. 519-888-4567)

Electronic Address:

Email:
Web Site:

Current Status:

Occupation:
Employer:

Additional Comments:

Use the area below to make any comments that you'd like to make in your listing.



Please enter the 6 character verification number listed to the right: