ALUMNI & FRIENDS INFORMATION
Street Address, Line1
Street Address, Line2
Country (if applicable)
Preferred E-mail Address
Home Phone Ex. (000-000-0000)
Cell Phone Ex. (000-000-0000)
Name at Graduation
Preferred Class Year or Year Last Attended
Program of Study While at DSLCC
We would be interested in knowing if you have a spouse/partner/child/parent who attended/graduated from DSLCC. Include the name under which they were enrolled at DSLCC, program of study, and year(s) attended.
Other Colleges/Universities You Attended - Years/Degree(s) Earned
Please let us know what you have been doing on a personal, educational or professional level.
Would you like this news to be considered for inclusion in future newsletters?
Digital photographs may be sent to firstname.lastname@example.org, while print photographs should be mailed to the Educational Foundation Office, P. O. Box 1000, Clifton Forge, VA 24422. Note: Digital photos submitted must be taken at a high resolution setting, generally 300 dpi or higher.)
In which of the following alumni services/programs would you be interested? (check all that apply)
Alumni Reunion/Family Picnic
Educational Lecture/Speakers Bureau
Mentoring for Students and/or Graduates
Serving on an Alumni Committee
Please check here if you are willing to volunteer with alumni activities/events.
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