Address and Information Update Form

Please fill out the form below.

Personal Information:

Last Name
First Name
Middle Initial
Maiden Name
Graduation Year
Degree Major

Marital Status:

Marital Status
Spouse/Partner Last Name
Spouse/Partner First Name
Spouse/Partner Middle Initial

If Spouse/Partner is an Alum:

Maiden Name
Graduation Year

Home Address:

Street
City
State
County
Zip
Phone
E-mail

Business Address:

Business name
Street
City
State
County
Zip
Phone

Other news (activities, honors, births, promotions, etc.):

Please send information on:

PSH Alumni Society
Volunteer Opportunities
Alumni Achievement Award
People to Watch Award
Alumni Mentor Program

Please send to:

Penn State Harrisburg, Alumni Office
777 W. Harrisburg Pike
Middletown, PA 17057-4898

or hbgalumni@psu.edu