Name

Email Address

Maiden Name

Spouses Name

Address

City

State

Zip Code

Phone

CSCC Completion or Graduation Year

Degree, Certificate, or Diploma Earned

Major

Employer

Job Title

CSCC Involvement: Programs, Clubs, Activities CSCC Involvement: Programs, Clubs, Activities Debate Early Childhood Education Forestry, Wildlife, & Fisheries Law Enforcement Training Music PTK Social Work

Healthcare: Which ones?

Sports: Which ones?

Other: Write in your specific involvement.

If you were in clubs, which ones?

Alumni Interest Alumni Interest Planning alumni events and programs Serving as a mentor to a student Donating to the Cleveland State Foundation Continuing Education Other

Message