Personal Information

First Name    M. I.    Last Name

Address    Phone () -

City    State    Zip

Social Security No.    Instrument

Age    Grade    GPA    ACT Score    Gender Male Female    Proposed Major

Parent/ Guardian First Name    M. I.    Last Name

Address (if different)

City    State    Zip

Day Phone () -    Evening Phone () -

Mother's Occupation    Father's Occupation

High School     Band Director's Name

School Address    Band Phone () -

Musical Background

Years of Private Study     Teacher's Name

Other Instruments You Play

Musical Honors or Awards:

Number of Years Band Experience   Marching  Concert    Number of Years Singing Experience

Chair Position     Part 1st   2nd   3rd   4th

What instrument do you own?

If you have any questions, comments or suggestions concerning the Alumni Information form, please contact Mr. Samuel Griffin:

Regular Mailing Address:

Mr. Samuel Griffin, Band Director
1000 ASU Dr. #270
Alcorn State University
Alcorn State, MS 39096-7500
Phone:  (601)877-6263 Fax:  (601) 877-6262
Email: griffin@alcorn.edu