Alumni Database Intake
Full Name:
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First Name
Last Name
Email:
*
example@example.com
Phone Number:
*
-
Area Code
Phone Number
Middlesex College Graduation Date:
*
-
Month
-
Day
Year
Date
Middlesex College Major:
*
What years were you an active member of the Juvenile Justice Reform Club (JJRC) and/or the Center for Justice-Impacted Students at Middlesex College?
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Are you currently in school?
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Yes
No
What is the name of your current institution?
*
What is your current major?
*
What are your future goals?
*
Would you like to receive updates from the JJRC and the Center for Justice-Impacted Students at Middlesex College?
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Yes
No
Would you be interested in serving as a resource (e.g., a guest speaker) for current JJRC members and students we serve as part of the Center for Justice-Impacted Students at Middlesex College?
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Yes
No
Would you be interested in providing a testimonial about your participation in the JJRC and/or the Center for Justice-Impacted Students at Middlesex College?
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Yes
No
Please describe how being a part of the JJRC and/or the Center for Justice-Impacted Students at Middlesex College benefited you both during and after your time at Middlesex College. In other words, what positive impact did the program have on your life?
Submit
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