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First Name (required)

Last Name (required)

Address 1 (Parent's or other permanent address)

City

State

Zip Code

Cell Phone Number

Email address (NOT your NSU email)

Birthday (MMDDYYYY)

Year Graduated

Degree 1

Major 1

Degree Term 1:

Degree 2

Major 2

Degree Term 2:

Spouse First Name

Spouse last Name

Is Your Spouse An NSU Graduate?

Employment Information

Business Name

Job Title (if known):

Business Address 1:

Business Address 2:

Business City:

Business Country:

Business E-mail:

Business Phone:

Business State:

Business Zip:

Student Involvement

What organization(s) were you a member of at NSU?

Other student group (not listed above)

NSU Athletics