Alumni Update Form Survey


Please complete this form accurately as the information you provide is used to update our databases. Your answers to the questions with an asterisk (*) are published in the alumni directory on the LR website. (If you do not want to use your business contact information, simply complete with the information you do want published.)

1.	Name*

2.	Title*

3.	Company*

4.	Business Address*

5.	City*

6.	State*

7.	Zip Code*

8.	Business Telephone*

9.	Email Address*

Please only fill out your home address information if it has changed in the past year.

10.	Home Address

11.	City

12.	State

13.	Zip Code

14.	Home Telephone

15.	Cell phone

16.	Residency

17.	Please indicate any interest changes since graduating from Leadership Racine. These selections are also listed in the alumni directory on the LR website. Select no more than 3 responses.
	Abuse prevention/treatment
	Aging/elderly
	Alcohol/drug abuse/substance abuse prevention
	Animal welfare
	Arts/humanities
	Community/neighborhood development
	Conservation
	Crime prevention/criminal justice
	Disabilities advocacy/physically challenged
	Diversity
	Domestic violence
	Economic development
	Education
	Employment training/issues
	Environment
	Family issues/organizations
	Fundraising
	Government (local, state, federal)
	Grant writing
	Health care/issues (physical, mental)
	History/preservation
	Homeless
	Housing
	Human relations
	Human services/social services
	Job development
	Land use
	Law enforcement
	Legal services
	Legislative issues
	Literacy
	Marketing/public relations
	Media
	Mentoring
	Non-profit management
	Nutrition/healthy living
	Parks and recreation
	Politics
	Public speaking
	Public transportation
	Publications/newsletters
	Quality of life
	Sales
	Social action
	Sports/entertainment
	Strategic planning
	Teaching/training
	Tourism
	Volunteerism
	Writing/editing
	Youth
	Other, please specify

18.	Please indicate any expertise changes since graduating from Leadership Racine. These selections are also listed in the alumni directory on the LR website. Select no more than 3 responses.
	Abuse prevention/treatment
	Accounting
	Advertising
	Advocacy
	Aging/elderly
	Board development
	Budgeting
	Business management
	Childcare
	Clerical/administrative
	Coaching/counseling
	Communication
	Community development
	Computers/technology
	Construction
	Criminal justice
	Diversity issues
	Education
	Employment training/issues
	Environment
	Engineering
	Event planning/management
	Finance
	Financial planning/investments
	Fund development
	Government (local, regional)
	Graphic design
	Grant writing
	Group facilitation
	Health care/issues (physical, mental)
	Housing
	Human relations
	Human resource management
	Insurance
	Language other than English
	Law enforcement
	Leadership styles
	Legal/liability issues
	Marketing/public relations
	Media
	Mentoring
	Non-profit organizations
	Nutrition
	Organizational planning/evaluation
	Project management
	Public speaking
	Publications/newsletters
	Retirement planning
	Research/evaluation
	Sales
	Strategic planning
	Teaching/training
	Team building
	Telecommunications
	Tourism
	Writing/editing
	Youth
	Other, please specify

19.	Please list any recent awards, recognition(s), achievements and promotions.

20.	Please add any personal information that you might want to share, e.g. weddings, babies, trips, education, insights, goals, etc.

21.	I would be interested in helping the Leadership Racine Alumni Association with:
	Membership
	Public Relations
	Special Events
	Continuing Education Programs
	Fundraising

22.	Do you have a topic idea for a continuing education program?

23.	Do you have a suggestion of a person to recruit for the Leadership Racine program? If so, please enter his or her contact information here.

24.	Keeping community people informed about Leadership Racine is important. Is there anyone else in your organization who should receive the Alumni Newsletter?
	Yes No