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

* 1. Name:

* 2. Name while at UCR, if different:

* 3. 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:

* 4. 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?

* 5. Class year:

* 7. Area of study:

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

* 9. Current occupation:

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

* 11. E-mail:

* 12. Mailing address:

* 13. 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:

* 15. Please share additional comments or suggestions:

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