1.	First Name (Preferred)*

2.	Last Name (Preferred)*

3.	First & Last Name used at DU (if different than preferred) Some people prefer to go by nicknames or alternative names, have changed names since attending, etc. We ask this in case there is a need to match alumns to enrollment records.

4.	Year of graduation (or last attendance, if no degree/certificate granted)* If you have multiple degrees, please list each graduation year. If no degree (yet), please list most recent year of attendance.

5.	Program of graduation (or last attendance)* What was your degree/major? (E.g., Law, Daniels, English, mediation, etc)

6.	What degree(s), if any, have you received from DU?* Please indicate all that apply. Select at least 1.
	Bachelor's (BA, BS, etc)    Master's (MA, MS, MBA, MSW, etc)    Doctorate (PhD, JD, PsyD, etc)    certificate (mediation, etc)    non-degree/certificate program    Other, please specify

7.	Email address* This means of contacting you will remain confidential. You will not be added to our regular contact lists unless you select to join the listserv below.

8.	Would you like to be added to our LGBTIQ Alumn Network email listserv?* This private, low-volume listserv is used by the LGBTIQA & Social Justice Initiatives program to keep alumns informed about opportunities. The subscriber list is NOT public, and the message traffic is very low.
	Yes No

9.	What would you most like this Network to provide you? For example, professional networking opportunities, connections to current students and new graduates, and/or insider info and discounts to campus and local events.