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COMMUNITY CONNECTIONS

Profile Information Update Form

Community Connections is trying to be greener! Please be sure to provide an e-mail address so we can reduce the amount of paper that we have to send.

First Name:
Last Name:
Participation: Match me as soon as possible.
      Please select me!!
Try me again in January.
Remove me from your list.
 
For those wanting a match now, please update your information:
E-Mail Address:
Email addresses enable us to send your newsletter and timely special event announcements electronically.
Daytime Phone No.:
Street Address:
City:
Zip Code:
I am currently volunteering with a student in:
Please indicate your volunteering status:
I plan to continue with my current student
I plan to continue with my current student, but would also like a new student.
I am no longer with a student and would like a new student for:
Do you have any special requirements?
 
If you have a student currently, please enter his/her information:
Student First Name:
Student Last Name:
University Department:
 
If you know anyone who might be interested in volunteering, please write his/her name(s) and telephone number(s) or e-mail(s):

 

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