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*First Name: Nickname: Middle Initial:
*Last Name:

My current address is:

Preferred Phone (please include area code):

Are you an NDSU Graduate? Yes No

If so, degree, class year, and major (Please list all degrees from NDSU):

*Preferred E-mail Address:

Employer Information (Employer, Position):

Additional degrees received from other institutions:

Spouse name and children's name(s):