Submit a Class Note: Birth

Child's Full Name

Date of Birth

(month, day, year) 

Gender girl boy

Mother's Full Name

Maiden name/
Name as student

Is mother an NC State Alum? yes no

Graduation Year(s)

Degree(s)

Mother's Employer

Job Title

Father's Full Name

Nickname

Is father an NC State Alum? yes no

Graduation Year(s)

Degree(s)

Father's Employer

Job Title

Street Address

City, State, and Zip

Home Phone

Email

If there are questions about this class note, contact me:

by telephone at my home phone number
by email at the address used to submit this form.

Include any additional information you'd like to share below.