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IU School of Nursing Military Service Survey

Note: Please print this page to complete the survey.

The purpose of this survey is twofold: 1) to identify graduates of the IU School of Nursing who have served in the military; and 2) to update our records so that we may maintain contact with our alumni.

If you did not serve in the military, please check here: ____
Please print this page and complete the data re: your name, current location, phone number and e-mail address and return the survey so that we may update our records. Thank you!

If you have served in the military, please print this page, complete it in full and return it. Thank you!

NAME:
MAIDEN NAME, IF APPLICABLE:
GRADUATION DATE(S) AND DEGREES:
ADDRESS:
PHONE:
E-MAIL:
HIGHLIGHTS OF NURSING CAREER: (Please attach separate page if necessary.)
BRANCH OF MILITARY SERVICE:
DATES OF SERVICE:
LOCATION OF SERVICE:
HIGHEST RANK ACHIEVED:
HONORS RECEIVED:
WAR TIME SERVICE: (Please clarify whether you served IN the war (deployed) or during the war (assigned)
ASSIGNMENTS (with location):

Any stories or pictures that provide a profile of your service would be greatly appreciated. Just attach it to the survey.

If you know of other IU School of Nursing graduates who served in the military, please give us their names and , if possible, how to contact them. (We will not use any data regarding their service without their permission)

If you are willing to give permission to the School of Nursing to list your name and service branch and rank, (on an honor list) please sign here: _______________________________________________

If you are willing to allow your stories or pictures to be used to recognize and celebrate those who served via brochures, books, booklets, wall mural, please sign here: ___________________________________

As the 100th anniversary approaches, we would like to celebrate those who served. We are not yet clear on the best way to do that (e.g. honor list, booklet, book, mural, listing etc). Suggestions would be welcome.

Please return this survey to:

Dr. Margaret Applegate
6420 E. Walton Dr. N
Camby, IN 46113
mapplega [at] iupui [dot] edu

OR

Mrs. Janet Mccully
Development Officer
IU School of Nursing
1111 Middle Drive, NU101
Indianapolis, IN 45202
jmccully [at] iupui [dot] edu

Thank you!