UA College of Nursing

Alumni Survey

Thank you for taking the time to fill out this short survey. Your feedback will assist us in planning a truly memorable 50th Anniversary celebration. Once you complete the survey, you will receive an email with your CON ID number, which may be used to access the Class Notes section of our website.

Note: Only fields in red will be posted on Class Notes.
Name (current)
 

Last:

   First:     Maiden:
 
Class of
    Month:   Year:    Specialty:
   

Degree: Bachelors   Masters  Doctoral  Certificate  Other 

              (check all that apply)

    if other, please specify:

 
Home Address
     Mailing:
     City:    State:    Zip:
 
Current Employer
  Company Name: 
  Your Title:
 
Work  Address
     Mailing:
                             
     City:    State:    Zip:
 
Current email
  Home:
  Business:
 
Current Phone
  Home ()  -
  Business ()  - x

 
Contact Preference:
 

I prefer written contact at:

 

I prefer email contact at: 

 

I prefer phone contact at:

     

  YES, I am currently working in the nursing field
 

If yes, tell us your area of nursing:

clinical practice    faculty     research
  YES, I am currently working in a non-nursing field
            If yes, tell us what field you are in:
  YES, I retired from nursing in
             because:

 

  Here is my feedback:  The 50th anniversary celebration would be most meaningful to me if:
 

 
  YES, I would be interested in helping to plan some part of the 50th anniversary.
  YES, I would be interested in attending a special event to celebrate our 50th year.
  YES, I would like to become active in the College of Nursing Alumni Council.
  YES, I may have some picture or memorabilia to share.
  YES, I would like to speak with someone about a gift to the College.

  I also would like to share these additional thoughts:
 

 
  YES, you may also post the following in Class Notes at the College of Nursing website. (Submit career advancements, papers presented, honors received, and recent appointments.)
 

 
 

The Alumni Survey is supported by the generosity of the UA Alumni Association, a Gateway Strategic Alliance Grant, the College of Nursing Alumni Council and the UA College of Nursing.