UPDATE YOUR PERSONAL INFO

Please fill out the entire form. Items with an asterisk(*) are required.
Please allow three weeks for changes to go into effect.


New Family Addition
* Your First Name:
 		Your Middle Name:
Maiden Name:
 		* Your Last Name:
Spouse First Name:
 		Spouse Middle Name:
Spouse Maiden Name:
 		Spouse Last Name:
* Address 1:
 		Address 2:
* City:
 		* State:
* Zip:
 		* Country:
* Daytime Phone:
 		Evening Phone:
* E-mail:
 		 
   
* Your Class Years:
 		Spouse Class Years (if they attended Ohio State):
Your Ohio State Degrees:
 		Spouse's Ohio State Degrees (if applicable):

* Child 1 First Name:
 		* Child 1 Last Name:
Child 1 Middle Name:
 		* Child 1 Date of Birth:
* Child 1 Sex:
 		 
If this is an adoption, please fill out the following:
Child 1 Date of Adoption:
 		Child 1 Country of Birth:


Child 2 First Name:
 		Child 2 Last Name:
Child 2 Middle Name:
 		Child 2 Date of Birth:
Child 2 Sex:
 		 
If this is an adoption, please fill out the following:
Child 2 Date of Adoption:
 		Child 2 Country of Birth:


Child 3 First Name:
 		Child 3 Last Name:
Child 3 Middle Name:
 		Child 3 Date of Birth:
Child 3 Sex:
 		 
If this is an adoption, please fill out the following:
Child 3 Date of Adoption:
 		Child 3 Country of Birth:



Do not publish in the Ohio State Alumni Magazine
Publish in the Ohio State Alumni Magazine and include E-mail address
Publish in the Ohio State Alumni Magazine but do not include E-mail address

Additional Comments: