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Home > Parents / Alumni > Alumni Information Form
Alumni Information Form
* required information
 
Contact Information
First Name:*
Last Name:*
Maiden Name:
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Country:
Phone:
Undergraduate Graduation Year:*
Degree:
College:*
Fraternity or Sorority Affiliation:
Profession:
If other, please explain:
Are you or any of your friends/family students or alumni of UCLA?: Yes
No
If so, please list the name, graduation year, and relationship to you.:
Brief Bio:
Would you like to take an active role in advancing Jewish life at UCLA?: Yes
No
Student Type:* Undergraduate
Graduate
UCLA Alumni
Not a student
(For Student Type please indicate if you were undergraduate/graduate at UCLA)
Are you planning to visit UCLA?: Yes
No
If so when? (mm/dd/yyyy):(mm/dd/yyyy)
Comments:
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