Alumni Association Questionnaire
(Printable Form)

Please complete and return to KSU Alumni Association, 1000 Chastain Road, #0056
Kennesaw, GA 30144
or FAX to (770) 499-3639

Dear KSU Alumna/Alumnus:

1. Are you interested in being a member of a KSU Black (African and African American) Alumni Society?

          ___Yes      ___No

2. It is the intent of the KSU Black Alumni Society to have a diversified program that will appeal to as many     of our alumni as possible. Please check as many programs below that you would like to see included on     our society:

    ____ Cultural lectures/seminars
    ____ Black Scholarship/Emergency Assistance Fund
    ____ Minority Student Recruitment and Retention Fundraising Programs
    ____ Social/Networking opportunities and activities
    ____ Family-oriented events, picnics, etc.
    ____ Alumni mentoring program for current KSU black students
    ____ Black Alumni Club Newsletter
    ____ Other(s):______________________________________

3. In what way would you like to work with this society?
    __________________________________________________

4. Are you interested in serving as an officer or board member.

        ____Yes      No, but I would like to serve as a(n)___________
                            _______________________________________

Name______________________________ SSN#______________
Address____________________________ City_______ Zip______
Home Phone__________ Work Phone_________
Email Address____________________________
Employer____________________________ Position_____________
Year of Graduation_______ Degree____________
List any KSU organizations you participated in while a student:________
_______________________________________________________
Additional Comments:_______________________________________
________________________________________________________
________________________________________________________

Email: rking@kennesaw.edu
This page last modified Friday, 10-Nov-2001
Copyright 2001 Kennesaw State University