First Name

Middle Name

Last Name

Name used at CSU, Chico

E-mail Address

Street Address

City State Zip Code

Primary Phone

Secondary Phone

Dates attended CSU, Chico

Major

Degree Earned

Profession

Business Name

Was your spouse/partner an EOP student at CSU, Chico?
Yes No

If yes, spouse/partner’s name

Dates spouse/partner attended CSU, Chico

Are you interested in being an EOP alumni contact for the EOP 40 year anniversary activities?
Yes No

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