Last Name*

First Name*

Initial

Gender
Male
Female

Street Address

Street Address 2

City

Country

Email*

Preferred contact method
call me
email me

Permanent Address

City

Fax

Employer

Position

Date Started

Employer Address

City

Area code and phone

Country code (If not a Canada number)

Preferred contact method
Home
Work

Keep me informed by e-mail on news and events at Herzing University.

Graduation Year

Program Completed

Have You Continued Your Education (School, Years, Courses or Degrees)

Memberships

Outside Interests

I am interested in participating in the following activities at Herzing University
Guest Speaker at Orientation or to prospective students or classes
Alumni Mentor Program
Herzing University Alumni Association
Herzing University Employer Advisory Council

If you keep in touch with other Herzing University alumni, please help us by entering the following information:

Name 1

Program

Phone or Email

Name 2

Program

Phone or Email

Name 3

Program

Phone or Email