See the source image

Chapter

Contact/Demographic Information Update

First Name

Last Name

Birthdate (mm/dd/yyyy)

Data matching purposes only

Personal Email Address

Work Email Address

Preferred Email

Phone Number

Mailing Address

Mailing City

State

Mailing Zip Code

Are you a Minds Matter alum?

Minds Matter Alum Year (the year you graduated high school)

Ethnicity

You chose other: Please Specify

Gender

Educational/Employment Information

Current Employer

Current Employer (Other)

Current Job Title

Does your company offer matching gifts?

Professional Background

Undergraduate College

Are you interested in helping us with fundraising and making pitches?

Other School

Major(s)

Year Graduated (Undergraduate)

Graduate School

Other Grad School

Graduate Field/Degree

Year Graduated (Graduate School)

Affiliations

Please indicate if you have a connection to any of the following companies:

Please indicate any other companies or foundations you may be connected to for a fundraising opportunity. Are you willing to make an intro?