First Name:
Last Name:
Maiden Name (if applicable):
*Email address:
*Date of Birth (dd/mm/yyyy):
*Program(s):
*Year(s) of Graduation:
*Campus Attended:
Student Number (if known):
*Street:
*City:
*Province/State:
*Postal Code / Zip Code:
*Telephone:
Home Fax:
Please send future mailings to:	Home Work
Spouse's Name:
Is spouse an SLC Alumni:	No Yes
Permanent Name & Phone Number of relative/parent/friend, who can always contact you:
Name of Institution:
Type:	College University Other
Program Name:
Year of Graduation:
Position/Title:
Employer's Name:
Employer's Address:
Employer City:
Employer Province/State:
Employer Postal Code/Zip Code:
Employer Telephone:
Employer Fax:
Employment email address (optional):
Additional personal notes:
Extracurricular Involvement @ SLC:
I am interested in getting involved with an Alumni branch in my area:	Brockville Cornwall Kingston Ottawa Toronto
If there is enough interest, I would like to see an alumni branch or chapter formed in or for:
STAYING CONNECTED WITH YOUR COLLEGE...:	I am interested in attending alumni branch and chapter events I am interested in offering co-op placements for graduates I am interested in hiring SLC graduates I am interested in studying part-time at St. Lawrence College I am interested in studying full-time at St. Lawrence College I am interested in getting Corporate Training I am interested in philanthropic support of the SLC Foundation I am interested in sponsoring student awards and bursaries (pers/corp) I am interested in planned giving of the SLC Foundation I would like to suggest a graduate for Premier Award or and Alumni Profile I am interested in offering an International student a homestay
...suggested alumni's name for award or profile:
Other:
*RELEASE OF INFORMATION:	Magazine and Website Magazine Only Keep Private
Please share these email addresses::	Home Email Business Email
*I am interested in providing a testimonial describing my time @ SLC:	No Yes
Enter your testimonial now if you are interested:
NOTICE: In accordance with Section 39(2) of the Freedom of Information and Protection of Privacy Act, the personal information on this form is collected under the authority of the Ministry of Colleges and Universities Act, RSO 1990, Regulation 770. The information is used for administrative and statistical purposes, for the notification and offering of benefits, programs and services for Alumni, and fundraising undertaken by the St. Lawrence College Foundation. It is used by St. Lawrence College, the Alumni Department and its partners, the St. Lawrence College Foundation, and/or the ministries and agencies of the Governments of Ontario and Canada. By submitting this form to St. Lawrence College, the user hereby authorizes the release of information herein or collected from a third party (such as a family member), to the aforementioned. Any questions concerning the collection and/or use of this information may be directed to the Colleges Alumni Office.