Former Staff Registration - Newman University, Birmingham

For information about how we will process your personal data please visit: http://www.newman.ac.uk/alumni-privacy-notice
Your Details
To begin, please provide some basic information about yourself.
Title * REQUIRED
Name * REQUIRED
First Middle Last
Surname as known whilst member of staff (if applicable)
Date of Birth - must be dd/mm/yyyy format * REQUIRED

DOB is a unique identifier that we use on our database.
Department worked for * REQUIRED
Last position held at Newman * REQUIRED
If academic member of staff, please identify your specialism
I worked at Newman from (Year): * REQUIRED
I worked at Newman until (Year): * REQUIRED

Contact Details
Please provide us with your up-to-date contact details so that we can keep in touch with you.
Address
Street Address Address Line 2 City County Post Code Country
Home Telephone
Mobile Telephone
Email
Social Media
We would like to keep in touch with you via Twitter and LinkedIn. Please provide your details below to enable us to connect with you.
Twitter Username
LinkedIn URL - enter a valid website URL for example https://www.google.com/

Current Employment Information
Please provide some information about your current employment
Employment Status * REQUIRED
Job Title
Employer
Town/City of Employment
If you are engaged in study, please let us know what course you are studying, and what institution you are studying at?
If you are self-employed and have a website or blog, please provide the web address below: - enter a valid website URL for example https://www.google.com/
Please add any additional information here (e.g achievements, awards, charity work etc.)

Your Details