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:
Varsity 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:
 
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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