XAVIER UNIVERSITY ALUMNI AFFAIRS OFFICE

ALUMNI INFORMATION FORM

PLEASE PRINT
SURNAME: ___________________________ FIRST NAME: ___________________________
(If alumna and married after graduation, please enter your surname as: Maiden Name-Married Name)
MIDDLE NAME: _______________________ NICKNAME: ____________________________
BIRTHDATE: (mm-dd-yy) __________________ GENDER: ______________________________
HOMETOWN: _________________________ HOME PROVINCE: ______________________

SCHOOL AND YEAR OF GRADUATION:

Degree & Concentration Name of School Year of Graduation

Grade School: __________________ _____________
High School: __________________ _____________
College: _________________ __________________ _____________
MA/MS: _________________ __________________ _____________
PhD: _________________ __________________ _____________

RESIDENCE ADDRESS:
____________________ _____________ _______________ _______________ ________
House No. / Street / Name of Subd. Barangay City/Municipality Province Country

Zip Code: ______________ Tel. No.: _________________ Cellphone: ________________

E-mail: ___________________________ Facebook Name: __________________________
ID Number: ________________

WORK /BUSINESS ADDRESS:

Company / Institution: _________________________________________________________
Department / Unit: ___________________________ Position: ____________________
Address: __________________ ____________ _____________ ____________ _________
Street Barangay City/Municipality Province Country

Zip Code: _____________________________ Tel. No.: __________________________

Fax: _______________ Cellphone No. _________________ E-mail: ___________________

Other info (on another sheet) e.g. published materials, awards, associations, notable achievements.
______________________________________ ___________________________________________

NAME OF SPOUSE: ___________________________________________________________

CHILDREN: _______________________ ____________________ __________________
_______________________ ____________________ __________________
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Please return this form to: XU Alumni Affairs Office, G/F STC Building, Xavier University, Corrales Ave., Cagayan de Oro City
Tel. No.: 853-9800 local 9217 E-mail Add: alumni@xu.edu.ph