Class Newsletter Questionnaire
FOR 1959 AND 1984 KCOM GRADUATES
ATSU-KCOM is publishing a newsletter for members of the anniversary
classes of 1959 and 1984. The newsletter will provide class
members with a great opportunity to connect with each other. To
participate, these class members can complete and submit this questionnaire
online by July 25 or print, complete, and mail
by July 25 to:
Janet M. Bunch
Director of Student & Alumni Projects
A.T. Still University
800 West Jefferson Street
Kirksville, MO 63501
A copy of the newsletter will be sent to members of the classes prior
to reunion events in Kirksville
October 15-16, 2009.
Please use the tab key or move the mouse to navigate through the survey.
Using the enter key will submit the form "as is" to ATSU-KCOM.
News of Interest:
Professional Affiliations (i.e., AOA, ACOFP, etc.):
Personal, Hobbies, Vacation Update:
What people or places do you remember most about your days at KCOM?
What else would you like to share with your classmates?
Information for Office Use Only (will not appear in the
Do you have children that are graduates of or are currently attending
an ATSU college/school (KCOM,
School of Health Management, Arizona School of Health Sciences, Arizona
School of Dentistry & Oral Health, School of Osteopathic Medicine in Arizona)?
If yes, please list their name, college/school attended, and year
graduated/anticipated year of graduation:
Do you have a child that may be applying to an ATSU college/school
within the next five years?
If yes, please provide their name and the college they are or will
Where do you want mail sent?
Where do you want email sent?
Do you plan to attend your class reunion events in Kirksville October 15-16, 2009?
Are you mailing a photo to appear in the Class Newsletter?
If so, would you like it returned?
Please remember to complete and submit the form by July 25. If you have any questions or comments,
please call 660.626.2067 or email email@example.com.
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