Palestine High School Alumni Association * PHSAA

Department of History Undergraduate Alumni Contact Form
Phone: (815) 753-0131
Please complete our Alumni Contact form so that we can stay connected. We are proud
of our graduates, and we enjoy hearing from them! The department of history is committed to
protecting your privacy. Any information collected is used solely for post-graduation
follow-up purposes. All information you provide to us is kept confidential. We will not sell
or disclose any information to a third party.
Complete Name: _____________________________________________
Z-ID_________________ Planned Graduation Date________________
NON-NIU Email Address: ________________ @ __________________
Street Address: ______________________________________________
City: _______________________________________________________
State: _____________
Zip Code: ________________