Fields in red are required

Name while attending Howard University

Prefix:
First: Middle Initial: Last:

Current Name (if different)

Prefix:
First: Middle Initial: Last:

1) Year Graduated: Degree:

2) Year Graduated: Degree:

Last four of SSN: Birthday (MM/DD/YY):
Gender:

Current Address

Street 1:
Street 2:
City: State/Province:

Zip Code: Country:
Home Phone#:
Email Address:

Are you a Member of the Howard University Alumni Association?
Yes No

Greek Afiliation:

Do you have any relatives that went to Howard University?
Yes No

If so, what are their names and class years?:

Other social affiliations while in school (i.e. ROTC, Football Team member, ect.):    

Employer Information

Employer Name:
Job Title:

Street 1:
Street 2:
City: State/Province:

Zip Code: Country:
Business Phone#:

Additional Comments/Suggestions: