Alumni Contact Request Form - West Virginia State University

Alumni Contact Report - Request Form

Chapter or Region*

Date of Request (MM/DD/YYYY)*

Purpose of Request*

Geographic Areas to be included in Report: Please note that reports will be generated to include all alumni within the state or states in which your chapter or region operates. If you wish for a detailed report of your area only, you must provide our office with all city names and/or zip codes of cities within your region.

Geographic Areas*

Requested Report Format (Check all that apply):

Paper Copy

Microsoft Excel Document (Email Only)

Contact Information for Request

Name*

Phone Number*

Mailing Address*

Email*