Please Tell Us . . .

This form will allow you to send the Office of Development and Information Systems your current information so they can update their records. Fields with an (*) indicate a mandatory field, please fill all of these out. When the form is completed, click the submit query button to send the form electronically.

To download the form and mail it to Clark rather than submit the information electronically:

1. Download Adobe's Acrobat Reader software, which is available free from Adobe.
2. Select the records form.

You will see the form and be able to print it.

About You

Has your home or business information recently changed?

Name *
Graduation Year *
Street Address *
City *
State *
Zip Code *
Country *
Home E-mail Address (write none if applicable)
Home Phone

Date of Birth (please format using MM/DD/YY, example: 12/2/70)
Marital Status
Surname while at Clark *

Business Information
Job Title
Company Name
Street Address
City
State
Zip Code
Business Phone
Fax Number
E-mail Address

Which address do you prefer your Clark mail sent to?

Home Business

Which e-mail address would you prefer us to use?

Home Business

About Your Spouse/Partner

Name
Date of Birth (please format using MM/DD/YY, example: 12/2/70)
Business Information
Job Title
Company Name
Street Address
City
State
Zip Code
Business Phone
Fax Number
E-mail Address

About Your Family

Child's Name Date of Birth
Child's Name Date of Birth
Child's Name Date of Birth
Child's Name Date of Birth
Did/do any of your relatives attend Clark?
Name: Relationship:

Name: Relationship:

Name: Relationship:

About Your Accomplishments

Please list your Clark degrees and years received.

Additional degrees and where received.

Please use this space to share any other information
you would like us to know about.