DACC Alumni Connection
The DACC Alumni Association offi ce would like to connect with you.
Please tell us about yourself, your family, and your life since you left DJC/DACC.
Information you supply may be used in the DACC Alumni newsle er sent
to alumni and friends.
Please complete the DACC Alumni Connection form below. If you have any
questions, please feel free to contact the Alumni Association offi ce at (217) 443-8798 or email alumni@dacc.edu.
A downloadable PDF form is available at h p://www.dacc.edu/assets/pdfs/alumni/alumni-enrollment.pdf and
h p://www.dacc.edu/alumni/newsle er.
Alumnus Information:
First Name: Middle Name:
Last Name: Maiden Name:
Address:
City: State: Zip:
Email: Preferred Telephone:
DJC/DACC Experience:
Years at DJC/DACC: ____/____ to ____/____
Favorite Class/Instructor:
Did you receive a scholarship?
Yes No
If yes, which one(s):
Graduate: Yes No
Degree/Certifi cate Earned: AAS ASA AES ADN AGS GED
Certifi cate(s):
Transfer: Yes No Transfer Institution:
I would like to receive the biannual emailed DACC Alumni newsle er: Yes No
Additional Education (Optional):
School: Major/Minor:
Degree Earned:
School: Major/Minor:
Degree Earned:
Have you returned to DACC since completing your degree/certifi cate? (check all that apply):
credit courses non-credit community education courses
customized corporate training career counseling/resume service
special event athletic event
professional meeting teach a class
Employment Information (Optional):
Field:
Job Title:
Employer:
Employer Location:
Family Information (Optional):
Spouse Name:
Is he/she a DACC Alumnus? Yes No When were you married?
Name of child: Age: School:
Name of child: Age: School:
Name of child: Age: School:
Name of child: Age: School:
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