Alumni Directory for Class Reunion - Milton Hershey School Alumni

Name*

First Last

Last name at graduation*

Preferred first name or nickname (for a name badge or salutation in a letter)

Nickname while at MHS

Class Year*

Email*

Does MHS have permission to send you email?

Yes
No

Do you give permission to MHS to publish the information on this form in a reunion class directory to be distributed to your classmates?*

Yes
No

Which version of the directory would you like to receive?*

PDF, to be sent via email
Paper, to be sent via regular mail

Street Address

Address Line 2

City

State

Province/Region

ZIP / Postal Code

Country

Is your mailing address new or changed in the last 6 months?

Yes
No

Preferred Phone Number:

Phone Type:

Cell Phone
Home Phone
Business Phone

Spouse or partner, if applicable:

Children, if applicable:

Please list your children's names if desired.

Grandchildren, if applicable:

Please list your grandchildren's names if desired.

If you have siblings who attended MHS, please provide their names and class years.

Please list the names of your siblings who attended MHS.

Please list the student homes where you resided when you attended MHS.

Please briefly list your current hobbies:

Please note your hobbies.

Awards received for community service or career accomplishments, if applicable:

Post-MHS education and major, if applicable:

Post-MHS education, including degree(s), major, and institution, if applicable:

Job Title

Employer

Is this your current job, or are you retired?

Current
Retired

Military Service*

Please Indicate if you have military service.

I have not served in the military.
I am currently serving in the military.
I served in the military, and was discharged.
I am retired from military service.

Military Service

Army
Navy
Air Force
Marines
Coast Guard
National Guard
Other (please explain below)

MHS Power of One

Please name one MHS staff member who helped make a positive impact on your life and briefly describe that impact.