Oklahoma State University Center for Health Sciences
Oklahoma State University Center for Health Sciences

Alumni Database Information Update

If you are an OSU College of Osteopathic Medicine graduate, please use this form to submit your contact information.

Help us keep in touch with you by providing your contact information using the form below. We will use this information to communicate with you and to help you stay connected with your fellow classmates. We protect your information and will not share it unless you request us to do so.

Thank you in advance for supporting your OSU-CHS Alumni Association!

Last Name
First Name
Preferred First Name (if different)
Middle Name
Maiden or Former Name
OSU-CHS Graduation Year
OSU-CHS Degree Earned
Hometown State
Spouse's Name
Date of Birth
Home Address
Home City
Home State
Home ZIP
Home Phone
E-mail Address
Cell Phone
Place of Employment
Work Address
Work City
Work State
Work Phone
Undergraduate College
Undergraduate Graduation Year
Undergraduate City
Undergraduate State
Undergraduate Degree and Major
Tribal affiliation (enrolled)
Tribes in which you hold a Certificate of Degree of Indian Blood

Additional Comments

Comments or Other Information

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