Personal Data Sheet

Print, complete, and return the following form to the department.

                           HISTORY OF ART DEPARTMENT

                              Personal Data Sheet


                                                         _______________
                                                               Date

Please complete in full

____indicates changes

Major_____         Minor_____       Probable Major_____

Class of _____________(year of graduation)


Name__________________________________________________
         last                          first

Social Security #__________________________________

Address/Local______________________________________

             ______________________________________

             ______________________________________

Telephone/Local____________________________________
                area code

Address/Permanent__________________________________

                 ___________________________________

                 ___________________________________

Telephone/Permanent_________________________________
                    area code