Alumni Member Data Release Form

I. DATA USE GUIDELINES

Mortar Board member data may be used for official Mortar Board business. Member records may not be sold, rented or distributed to any external organization or business for any purpose. Inform the National Office immediately if there is any breach of this protection or if there is a use that you would like to discuss with us, like sharing it with your institution’s alumni association.

Sometimes a member requests that information not be shared. In that case, the National Office provides name and initiation date but withholds contact information.

Please do not add alumni email addresses to your general chapter listserv. Alumni members should only be contacted by email when your chapter has events or initiatives specifically targeted to them (e.g., your chapter is hosting an alumni reunion).

Member information is very changeable. Please send any updates to member records that you receive to the National Office, either in batches or one at a time. This includes information on returned mail labels and if mail/email is returned to you with an invalid address.

II. DATA REQUEST

Your Name

First NameLast Name

Position

Email

Phone Number

Area CodePhone Number

Advisor name

First NameLast Name

Advisor Phone Number

Area CodePhone Number

Advisor email

Chapter name

College/university

How do you intend to use this data?

When do you need the data?

Please indicate what type of alumni records you need.

If you are not sure, please describe the ways that you intend to use the data.

The National Office will supply data based on the cities or postal codes that you provide in this request. If, for example, you want a list of all members in Chicagoland, you will need to supply all the city names or ZIP codes in that area. The National Office cannot do this research for you. There are search engines and websites such as Google and Zip-codes.com that may be helpful to you as you prepare your request.

Cities or ZIP codes to include

III. DATA USE AGREEMENT

By my initials below, I indicate that my chapter and I will use the information requested for the purposes described on this form above and no other and that we will abide by the Mortar Board privacy policy. I also agree to provide the National Office with updated information about members that my chapter and I receive.

Initials

Date