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Fill in as much information as you like below and submit to the Alumni office.   For a change of address, simply fill out the relevant section and indicate where we should send mail.  Thank you for staying in touch!

Personal First name M.I. Last name   Maiden Name Mr. Ms. Mrs. Dr.            Nickname Date of Birth (year is optional) Address Address (cont.) City State/Province State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Zip/Postal code  Country Send Mail to: Home address    Business address Seasonal address (enter below and indicate dates if seasonal) Other address: Home Phone FAX  Seasonal Phone     Dates of above E-mail WWW URL    Employment Job Title Employer Name Employer address Address (cont.) City State/Province State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Zip/Postal code Country Phone FAX E-mail URL    Other Degrees Institution Degree Year of Graduation     Institution Degree Year of Graduation    Marital Status   Single  Married    Life Partner   Divorced   Widowed/Widower    Spouse/Life Partner Name Occupation Date of Marriage     Bloomfield College Alum? Yes  No    If yes: Year of Graduation     If no: School, degree, year     Children (Name, age, date of birth)          News - Indicate any news, information, or updates that you would like us to print in the next issue of On the Green.