Annuitant and Alumni Profile Form

Name Name Title First Last Suffix
Your name while attending Eastern (if different)
What's your relationship with us?

What's your relationship with us? Annuitant Alumni Current Student Friend of the Department
Please take a moment and share what you've been up to lately. (personal, professional, family, etc.)
What associations or organizations are you involved with? Have you received any degrees or certifications in the last few years?
If you were or are a student, what was your major or concentration?
When were you here?
Let's Keep In Touch!

We'd love to keep in touch. If you don't mind, please provide contact info and answer some questions about your time at EIU.
Current Address Current Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Daytime Phone Daytime Phone - ### - ### ####
Business/Career Information
Business/Workplace Name
Business Location
Title/Position
Business/Workplace Website
Shout Out!

Have photos you want to share?
Interested in being featured in an upcoming issue of the BIO Briefs Newsletter?
Let us know!
Upload a File

Attach Files
Upload a File

Attach Files
I would like to share how my EIU experiences contributed to my success
Anything else you want to tell us?

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