Alabama's Public Liberal Arts University

ALUMNI & FRIENDS

Alumni Record Update

Use this form to submit address changes and/or

news for Montevallo Today alumni magazine.

First Name*
Last Name*
Middle Initial
Title* Other 
Sex Male Female
Date of Birth i.e. 01/01/65
Maiden Name
Undergraduate Degree Received
Year Received*  
Graduate Degree Received
Year Received  
Graduate Degree Institution

Marital Status

 Single Married Divorced Widowed
 Spouse Name
Is spouse UM graduate? Yes No
   If yes, graduation year  
 Street
P.O. Box
City*

State/Province*

ZIP*
Country
Home Phone
i.e.(205) 777-9999
Cell Phone
Preferred E-mail Address*
  If updating your address, please give us your previous address information.
Previous Street
Previous P.O. Box
Previous City, State, ZIP
Previous Country
  * Indicates Required Information

Please provide the following information:

Employer
Job Title
Street Address
Address (cont.)
City
State/Province
ZIP
Country
Work Phone
i.e.(205) 777-9999
URL
What's New?

At Home/At Work?

(Information to

be included in Montevallo Today alumni magazine)

* Indicates required fields.

Please submit pictures via e-mail to millerkd@montevallo.edu