Communication Sciences and Disorders Affiliate Program Group

Please complete this form to update the CSD department and fellow alumni on your personal news. You may complete the form below using this browser and submit it to us on-line or you can print out the form, complete it, and mail it to us. Your submission may be edited for brevity and style. Personal information, such as your address and phone number will not be printed. Your email address will only be printed with your permission.

By submitting a completed form you are giving the CSD department permission to include your news on the main Communication Sciences and Disorders web page as well as in the on-line repository, Where Are They Now. The Where Are They Now page is updated periodically and previous entries are removed to the site's archive.

Name*:

Current Address:

City:

State:

Zip Code :

Phone:

(XXX-XXX-XXXX)

Email Address* :

Permission to print Email Address:

 Yes No

Is this a new address?

 Yes No

Degree:

Class of :

My Employer is :

My Position/Title is:

Address:

  
Street
City
State
Zip Code

Phone:

(XXX-XXX-XXXX)

Internet Address:

Is this new employment information?

 Yes No

Include a short paragraph with information about: Promotions, Honors, Marriages, Births, etc. (with marriages, include spouse's first name, maiden name; with births, include child's name)

Please include a short paragraph on how your CSD degree helped you get where you are today.