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Title

First Name*

Middle Name

Last Name*

Suffix

Former name(s) (If your surname has changed)

Address (Parent's or other permanent address)*

Address line 2

City*

State*

Zip Code*

Cell Phone Number*

Email address (Not your NSU email)*

Birthday (MMDDYYYY)*

Degree Information

Year Graduated

Degree 1

Major 1

Degree Term 1:

Degree 2

Major 2

Degree Term 2:

Spouse Information (Optional)

Spouse First Name

Spouse last Name

Is Your Spouse An NSU Graduate?

Employment Information (Optional)

Business Name

Job Title (if known):

Business Address 1:

Business Address 2:

Business City:

Business Country:

Business E-mail:

Business Phone:

Business State:

Business Zip:

Student Involvement (Optional)

What organization(s) were you a member of at NSU?

Other student group (not listed above)

NSU Athletics