UC Riverside LGBT/Allies Alumni Form

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Help us build a network of UC Riverside LGBT/Allies Alumni by completing this form.

1. Name while at UCR, if different:

Name while at UCR, if different:

2. Name:

Name:

3. The LGBT Resource Center is developing a Career Contacts mentoring program that connects current students with alumni and friends in the workplace. Do you have an interest in being part of this new initiative?

The LGBT Resource Center is developing a Career Contacts mentoring program that connects current students with alumni and friends in the workplace. Do you have an interest in being part of this new initiative? Yes

4. By marking the boxes below, you give permission for the LGBT Resource Center to add your information to the LGBT/Allies Alumni Roster web page:

By marking the boxes below, you give permission for the LGBT Resource Center to add your information to the LGBT/Allies Alumni Roster web page: Name

Class Year

Degree(s)

Area(s) of Study

Your current City and State

Current Occupation

E-mail

5. Class year:

Class year:

6. Degree:

Degree:

7. Area of study:

Area of study:

8. If you earned a 2nd degree from UCR, indicate type, study area, and class year:

If you earned a 2nd degree from UCR, indicate type, study area, and class year:

9. Current occupation:

Current occupation:

10. E-mail:

E-mail:

11. Where do you currently live? (City, State):

Where do you currently live? (City, State):

12. Mailing address:

Mailing address:

13. Phone:

Phone:

14. Please share any ideas of how UCR LGBT/Allies Alumni could be actively involved in networking with each other and/or supporting current UCR students:

Please share any ideas of how UCR LGBT/Allies Alumni could be actively involved in networking with each other and/or supporting current UCR students:

15. Please share additional comments or suggestions:

Please share additional comments or suggestions: