QEH Information Survey

Information Survey

Name and Personal Information
*(Please include title, surname and any distinctions - eg J E Carr OBE)

*Forename(s) (preferred name in brackets)

*Address line 1:
Address line 2:
*Town:
*Post Code:
*Country:
Telephone:
Mobile:
*Email:
*Year started at the school:
*Year left the school:
*Are you a member of Old Boys’ Society?:
*Date of Birth:
*University:
*Degree:
Employment Details
Please give details of your present employment
Job Title:			I have retired

Current Employer:

City:

Relatives at QEH and birth date (where known)
Names of relatives who have been to or are at QEH and their relationship to you (in brackets)

News and Stories about you
Would you be prepared to speak at 6th form lectures?				Yes No
Would you be willing to take 6th form boy's on Work Experience?				Yes No
Would you be willing to help the school in any other ways?				Yes No
(if 'yes', please specify)
Please add any news you have, or stories you would like to share with us, CV or biography would be welcome:

We take data security very seriously. As an anti-spam measure, please enter the Security Code from the box below (please note it is case sensitive):