Former staff

Personal Details

Title

If Other

First name

Surname

Name as known while member of staff (if applicable)

Gender

Date of birth

Date of birth - DayDate of birth - MonthDate of birth - Year

Address

City

County

Postcode

Country

Contact telephone

Email

This will be the email address you would like email newsletter and other correspondence to go to.

Your employment at the University

Faculty/Department you worked for

If Other please specify

Last position held during employment

If academic member of staff please identify your specialism

I worked at the University from

To

Current Employment Details

If Other give details

Please give details of your current or most recent employment

What industry do you work in? e.g. education, IT, Engineering etc.

Employer

Job Title

Town

County

Postcode

Telephone number (inc code)

Work Email

Additional Information

Please add any additional information here (e.g. achievements, awards, charity work etc.)

We will never give or sell your details to external organisations. We may use your details for other Birmingham City University marketing purposes.

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Would you like to stay in touch with us?

Yes, I would like to stay in touch with you and understand my information will be used by Birmingham City University as set out in the ‘How we will use your personal data’ section

I would like to receive alumni communications by

Email

Post

Phone

SMS