Please update the information below so that we can stay in touch with you. By staying in touch you will receive:

• News on City College School of Nursing Alumni Activities
• Your information on the City College Nursing Alumni web page! 
  Only the information in red will be added to our Alumni web page

About Yourself! 

Your Title:

Mr. Mrs. Ms. Miss Dr. Dean Professor Councilman The Honorable Sister Reverend Father Other  

First Name:

, Middle Initial:

Last Name:

Maiden/Previous Name:

Street Address:

City, State, Zip Code:

, Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New York Nevada New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming ,

Country:

,
Please include Providence, Territory or State along with Country. (i.e. Perth, WA Australia)

Home Phone, Fax:

*Please include all country codes if Home Phone is foreign. Limit 20 spaces.

E-Mail:

Yes, I want to be included in the Alumni Web email directory

Do you have a web site?   WWW Address

Degree/Certificate Earned at City College:

Associate Degree Nurse (Generic) Associate Degree Nurse (LVN-RN/ Advanced Placement) LVN 30 Unit Option Vocational Nursing  

Graduation Year from City College:

Additional Schools/Degrees Since City College:

School/University   Title
                 Major            Year

About Your Employment!

Employer Name:

Occupation, Title:

,

Department:

Address:

City, State, Zip Code:

, Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New York Nevada New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming ,

Country:

*Please include Providence, Territory or State along with Country. (i.e. Perth, WA Australia)

Phone, Fax:

*Please include all country codes if phone is foreign. Limit 20 spaces.

Business E-Mail or
Personal E-mail:

Class Notes: