Alumni Necrology Reporting Form - Alcorn State University

* Required

Point of Contact (Person Submitting) *

Phone Number (mobile/cell) *

Email Address *

Relationship to Decedent *

Decedent Information

Deceased Alumnus Full Name *

Date of Birth *

Class Year or Dates Attended *

Hometown *

Home State: *

Home Zip Code *

Major/Academic Department *

Degree

Career/Occupation or Retired

Name of Last Employer

Date of Passing *

Most Recent Residency (city, state, country) *

Type of Service (graveside, memorial, funeral, etc.)

Date of Service

Time

Service Location Name

City

State

Funeral Home/Mortuary Company

Name

Phone

Special Requests for Announcement (i.e.Send flowers, donations, expressions to)

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Additional information and/or comments

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