*
Required
Reunion Survey of Alumni
Personal Information
Name
*
required
Please enter first, middle, and last name.
Title
Suffix
Maiden Name
(if applicable)
Nickname
Class Year
Did you graduate?
Yes
No
I was a
day student
boarding student
Years attended:
Ethnicity
With which race/ethnicity do you most identify? An important priority of the Alumni/Development Office is to offer events, communications, and activities that represent and bring together our diverse alumni body of which we are proud. If you feel comfortable self-reporting the following information, it would help us keep accurate school data so that we can serve you better.
Black/African American
Asian/Asian American
European American/White
Latinx/Hispanic/Hispanic American
Middle Eastern/Middle Eastern American
Multiracial/Multiracial American
Native American
Pacific Islander/Pacific Islander American
Prefer not to respond
Home Address
Address 1
Address 2
Address 3
City
State
Region
Zip Code
(ex. 06108 or 06108-0809)
Country
Home Phone
Cell Phone
Home email
Seasonal Address
Address 1
Address 2
Address 3
City
State
Region
Zip Code
(ex. 06108 or 06108-0809)
Country
Seasonal Phone
Months of Year at Seasonal Address
What is your preferred mailing address?
Home
Business
Other
If other, please specify:
What is your preferred email address?
Home
Business
Other
If other, please specify:
Occupation Information
Occupation
Active
Retired
Other
If other, please specify:
Employer
Occupation
Title
Business Address
Business Phone
Business Email
Is your current employer a matching gift company?
Yes
No
Other
If other, please specify:
Past Work Experience
Employer
Occupation
Title
Dates Employed
Additional Employment Information
Estate/Life Income Planning
Estate/Life Income Planning:
I have included Loomis Chaffee in my will.
Please provide me with information about planned gifts.
College and Graduate School Information
College(s)/Major(s)/Degree(s)/Year(s) of Award
Family Information
Marital Status:
Single
Married
Partner
Divorced
Widowed
Spouse/Partner Name
Spouse/Partner College
Spouse/Partner Employer
Do you have children?
yes
no
Children:
Full name, date of birth, and secondary school and/or college.
Do you have grandchildren?
yes
no
Grandchildren (with ages):
Full name and date of birth.
Do you have relatives with a Loomis Chaffee affiliation?
yes
no
Relatives with Loomis Chaffee Affiliation (past and present):
Name, affiliation (class year, family, etc.), and relationship.
Affiliations
Professional Organizations
Club Memberships or Societies
Primary Charitable Organizations/Volunteer Activities
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Please provide an email address where we can send a link to your current form.
Email Address :