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Penn State Alumni Student-Athlete Questionnaire

Salutation   If other, please specify:  
 

First
Middle
Current Last Name
Birth/Maiden Name
 

Preferred Nickname
Graduation Year
Major		 Gender  
 
Sport(s):
 Roles - Select all that apply:
Player at University Park
Manager
Coach
Captain
 Relationship Status  
Spouse / Partner Name, if applicable
 
Mailing Address


Street Address

  


City/Town

 


State

  


Zip
 

E-mail
Home Phone
Cell Phone
Work Phone
 

Current Employer
Job Titles
 
Work Address


Street Address

  


City/Town

 


State

  


Zip
 
I give my consent to share my contact information with:

    A. Former athletes from my sport
    B. Former athletes from my class
    C. All former athletes
    D. Do not share my contact information

 I give my consent to share the following information (check all that apply):
    A. Home mailing address
    B. Home phone
    C. Business mailing address
    D. Business phone
    E. email address
 
Do you have any news about spouses, partners, children, family or your athletic career after Penn State that you would like to share with us?

 
Do you have any of your teammates contact information? If so, please fill-in in the space provided.

 
Comments or Inquiries:

Verify characters:

 
Have you registered at www2.go2athlete.com, the official professional site for current and former Penn State student-athletes?
Yes     No
 
Please note- your contact information will be forwarded to the Varsity S Club and the Alumni Association.
 
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