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Please note that degree and faculty information is collected to help identify your record in our system; if you have more than one degree that you would like to provide information on, please do so in the comment field at the end of this form.

Affiliation with Dalhousie

Affiliation

Last Faculty Attended

Degree*

Degree Year*

Personal Information

Salutation

First Name

Middle Name

Last Name

Maiden Name

Preferred Name

Email Address*

Gender

Date of Birth MM/DD/YYYY

Banner ID Example: B001234567

Home Address/Phone Information

Unit Number Example: 305A

Address (line 1) Example: 22 Main St

Address (line 2) Example: PO Box 444

City/Town

Country

Province/State

Province/State Or Region/District/County/Territory

Postal Code/Zip

Home Phone:

Area

Number

Set as preferred

Business Address/Phone Information

Company Name

Position/Profession

Unit Number Example: 305A

Example: 22 Main St Address (line 1)

Example: PO Box 444 Address (line 2)

City/Town*

Country

Province/State

Province/State Or Region/District/County/Territory

Postal Code/Zip

Business Phone:

Area

Number

Ext.

Business

Preferred Mailing Address

Home

Business

Additional Comments

Please be sure to check the form to make certain your information is correct. You will receive an automatic notice at the email address you provided.

Privacy: The information provided on this online form will be used by Dalhousie's Office of Advancement. Personal information contained in our records will be kept in confidence and will be used for Dalhousie-related purposes only.

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Office of Advancement