| Basic Information |
| 1. |
How would you like us to address you?
Prefix:
Mr. Mrs. Ms. Miss Dr. Other:
First, Middle, Last
Suffix:
Jr. Ph.D. M.D. Other:
|
| 2. |
Home Address
Street Address
Street Address
City
State
-
Zip Code +4
Country
|
| 3. |
Home Telephone () - Check if unlisted |
| 4. |
Home Fax () - |
| 5. |
Home E-mail Address |
| 6. |
Home Web Page URL
http://
|
| 7. |
Seasonal Address from (MM/DD)
/ to (MM/DD) /
Street Address
Street Address
City
State
-
Zip Code +4
Country
|
| 8. |
Seasonal Telephone () - Check if unlisted |
| 9. |
Where do you prefer to receive your Carleton mail?
Home
Business
Seasonal during the above dates then: Home Business
|
| 10. |
Preferred First Name or Nickname |
| Life After Carleton |
| 11. |
Other Degrees: Degree, Year, College/University, Major
(If you have more than three advanced degrees please send email or U.S. mail so we can update our records.)
|
| 12. |
Current Marital Status:
Married
Single
Widowed
Partnered
Other:
|
| 13. |
Spouse/Partner Information
Name
Job Title
Employer
Business Address
Business Address
City
State
-
Zip Code +4
Country
|
| 14. |
Spouse/Partner Education
Degree, Year, College/University, Major
Degree, Year, College/University, Major
Degree, Year, College/University, Major
|
| 15. |
Children
Note: If you have more than four children, please contact us by phone number or email.
1.
Name, Date of Birth, Sex
College/University, Degree, Year
2.
Name, Date of Birth, Sex
College/University, Degree, Year
3.
Name, Date of Birth, Sex
College/University, Degree, Year
4.
Name, Date of Birth, Sex
College/University, Degree, Year
|
| 16. |
How would you like us to address you in joint mailings?
For example,
Mr. and Mrs. John H. Smith
or
Mr. John H. Doe and Mrs. Mary Q. Doe
|
| Career Information |
| 17. |
Occupational Status
- Employed full-time
- Employed part-time
- Self-Employed
- Volunteer
- Retired
- Homemaker
- Seeking employment
- Degree-seeking student-- please indicate:
College/University, Subject area/field of study
Anticipated degree (MA, PhD, etc.), Anticipated degree date (mo/yr)
|
| 18. |
Primary Employer (Including self-employed; if retired, last position held)
Job Title
Employer
Business Address
Business Address
City
State
-
Zip Code +4
Country
|
| 19. |
Business Telephone () - |
| 20. |
Business Fax () - |
| 21. |
Business E-mail Address |
| 22. |
Business Web Page Address
http://
|
| 23. |
Matching Contributions
Does your employer match gifts to non-profits?
Yes No Unsure
Does your spouse's employer match gifts to non-profits?
Yes No Unsure
If retired, do you retain matching gift benefits from your former employer?
Yes No Unsure
|
| 24. |
Should you move and become "lost" on our records, whom may we contact at an address other than those listed above to find your correct address?
Name
Street Address
City
State
-
Zip Code +4
Country
|
| Thank you for helping Carleton update its records. |
| please choose either: or |
