Alumni Generation Form | Lakeland College

Graduate Information

Your First Name:*
Middle Name/Initial:
Last Name:*
Email_Address*
Permanent Address:*
Town/City:*
Province/State:*
Postal/Zip Code:*
Phone (with area code): *
Alumnus Information This form allows you to identify up to 3 alumni relationships. If you have more than 3, please fill in a second form.
Alumnus Relationship 1:*	FatherMotherGrandfatherGrandmotherGreat GrandfatherGreat Grandmother
First Name:*
Last name:*
Maiden Name:
Deceased
Year of Study:*
Program:*
If this person is deceased, please put na in all the address spaces.
Address:*
Town/City:*
Province/State:*
Postal/Zip Code:*
Alumnus Relationship 2:	FatherMotherGrandfatherGrandmotherGreat GrandfatherGreat Grandmother
First Name:
Last Name:
Maiden Name:
Deceased
Year of Study:
Program:
If this person is deceased, please put na in all the address spaces.
Address:
Town/City:
Province/State:
Postal/Zip Code:
Alumnus Relationship 3:	FatherMotherGrandfatherGrandmotherGreat GrandfatherGreat Grandmother
First Name:
Last Name:
Maiden Name:
Deceased
Year of Study:
Program:
If this person is deceased, please put na in all the address spaces.
Address:
Town/City:
Province/State:
Postal/Zip Code:

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