La Casa Alumni Contact Information Form | La Casa Cultural: Latino Cultural Center

Name *

Ethnic Background

Gender

Address

Phone Number

Email Address

Primary Contact

College

Year *

Undergraduate Degree *

Other Degrees

What Latinx Organization(s) were you involved with?

Company Name

Title

Please include any information you’d like to share with us! Tell us about your family, any current ties with Yale, etc.

Tell Us About Yourself

Mark either yes or no to the following:

	Yes	No
I would like to receive more information about Yale Latino Alumni.	I would like to receive more information about Yale Latino Alumni. - Yes	I would like to receive more information about Yale Latino Alumni. - No
I would like to get involved with Yale Latino Alumni.	I would like to get involved with Yale Latino Alumni. - Yes	I would like to get involved with Yale Latino Alumni. - No
I would like to be added to the Yale Latino Alumni email distribution list.	I would like to be added to the Yale Latino Alumni email distribution list. - Yes	I would like to be added to the Yale Latino Alumni email distribution list. - No
I would like to complete the survey to add my recommendations to assist with the growth of Yale Latino Alumni and the strengthening of the Yale Latinx community.	I would like to complete the survey to add my recommendations to assist with the growth of Yale Latino Alumni and the strengthening of the Yale Latinx community. - Yes	I would like to complete the survey to add my recommendations to assist with the growth of Yale Latino Alumni and the strengthening of the Yale Latinx community. - No
I am not interested in receiving further correspondence regarding Latinx alumni activities at Yale.	I am not interested in receiving further correspondence regarding Latinx alumni activities at Yale. - Yes	I am not interested in receiving further correspondence regarding Latinx alumni activities at Yale. - No