Southern University and Agricultural and Mechanical College

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SU Connect Participation Form

E-Mail Address
Name

(First Name)

(Last Name)
Job Title
Company/Organization
Address
City
State
Zip Code
Phone Number
Profession
Email Address
Degree(s)
Year Graduated
Manager
Yes
No
Highest Level Management
Level of participation or any suggestion that describes how they would like to connect with us.
Mentor
Company Ambassador
Other
If other
Reference and Phone Number
Reference and Phone Number