Personal / Contact Information
First Name:
Last Name:
Home Address Line 1:
Home Address Line 2:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Country:
Preferred Phone Number:
.
.
Preferred E-mail Address:
La Salle Student ID Number (7 digits, if known):
If you work in a different city or town than you live, would you be willing to recruit students near your workplace?
yes
no
If yes, please list the city, state and county where you work:
La Salle / Graduate Information
Along with the geographic connection, we may also connect you with students who share similar study and career interests as you. The information you provide below will help us make additional links with students and you.
Year of Graduation:
Major:
Degree:
Current Employer:
Job Title:
If you feel it is necessary, please provide a brief description of what you do for a living:
Other Information:
Please list nearby high schools, or high schools with which you have a special connection. We will link you with the college fairs and students associated with these high schools, and, possibly, other high schools in the vicinity as well.
If you are a parent, have any of you sent any children to attend La Salle University?
Please Select one
yes
no
Please provide any additional
Thank you, we will be in touch soon.
