Alumni Directory Update Form

XMA Alumni Directory Update Form

This form allows you to add or update your information and/or picture for our Alumni Directory. The information gathered through this form will be used for internal Teachers College purposes only, and will be accessible to XMA Alumni, Faculty, Staff, and in the spirit of collaboration, with the Office of Alumni Relations. It may be used in the following ways: a) shared with the XMA Alumni Association via the electronic and print Alumni Directory; b) used for communications from the XMA Alumni Leadership Team; c) used for Office of Executive Education-wide communications; and d) used for Office of Alumni Relations communications. Basic information (name, cohort #, location, role/organization) drawn from Module 1 bios will be included in the directory for Alumni who do not complete this form, unless we are otherwise notified. If you have any questions or technical issues, please email the OD Coordinator at odcoordinator@tc.columbia.edu. Thank you for completing this form!
Name*

First NameMiddle Name/InitialLast Name
E-mail (please enter the best email for XMA Alumni, Faculty, Staff, and Alumni Relations to use when contacting you)*
What cohort are/were you in?*
Please indicate your location (e.g., City, State, Country, etc.)*

Postal / Zip Code
What is your current title and the organization at which you work?*
Please provide a brief description of your role
What are the areas/topics within Change Leadership/OD that are of interest to you (e.g., leadership, coaching, group dynamics, culture, etc.)?
Current Mailing Address (optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please upload a picture of yourself, for use in the Alumni Directory (please note that if you do not upload a picture, the picture you submitted for your Module 1 Bio will be used)

Upload a File

Cancelof
Please select one option below:*

YES, I would like for my information to be included in the XMA Alumni directory to be shared only within the alumni community, the XMA Program Office, and Alumni RelationsNO, I would not like for my information to be included in the directory. Please simply keep my updated information within TC for ongoing communications.
Please indicate your agreement with the following statement, before submitting this form:*

YES, by checking this box I understand the intended use of this information and upon receiving access to the information, agree NOT to use it or share it for solicitation purposes in ANY way
Thank you for your participation! Please contact the OD Coordinator at odcoordinator@tc.columbia.edu with any questions or concerns.
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XMA Alumni Directory Update Form

Thank you for your participation! Please contact the OD Coordinator at odcoordinator@tc.columbia.edu with any questions or concerns.