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Alumni Directory Information

 

Capital University
School of Nursing

Last name
First name
Middle/Maiden
Name while attending CU School of Nursing
Degree(s) and date(s) from Capital:

Address
City
State
Zip Code 
E-mail address (home)
E-mail address (work)
Area Code & Phone Number (home)
( )-

Marital Status
Spouse's name (if applicable)
Is spouse a CU Alumnus/a?  No  Yes 
If yes, degree(s) and year(s)

 
 
Children?
No  Yes		 If yes, names and ages
Have any of your children attended or graduated from Capital?
No  Yes		 If yes, what degree(s), date(s) of attendence, etc.

Current position and/or job title 

Years in this position 

Name and address of place of employment

Additional education (degrees/certifications, etc.) after graduation from Capital

Professional memberships

Publications, awards, special honors, etc.

Community service activities

Classmates with whom you've kept in touch

Faculty members with whom you've kept in touch

Faculty mentor(s)

Are you receiving CU School of Nursing publications?  No  Yes
Do you read them?  No  Yes

Other information you would like your classmates to know

Please complete and return this form to Sharon Coil, Secretary.  This information will be compiled and made available to alumni.  It will not be sold to anyone and will be used solely for and by Capital University and the School of Nursing.  Please return by submitting this form, by e-mail, by U.S. mail, or by fax.  E-mail:  scoil@capital.edu  U.S. Mail:  Capital University School of Nursing, 2199 E. Main St., Columbus, Ohio 43209.  Fax: 614-236-6157.

 




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