Requestor's Information
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* First Name
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* Last Name
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Maiden Name (if applicable)
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* Relationship to Kirkwood
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If Alumni, please list years attended or graduated and program.
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If other, please describe your relationship to Kirkwood.
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* Email
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* Confirm Email
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* Phone Number
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* Street Address
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* City
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* State
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* Zip Code
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Event Information
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* Name of Event
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* Anticipated Attendance
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* Event Date or Target Date (e.g. March 25, 2026 or Spring 2026)
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Event Time
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Event Location
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* Brief Description and purpose of event
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* Support desired (Select all that apply)
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Yes No Provide Alumni and Friends promotional Items
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Yes No Provide funds to support the event (e.g. Provide appetizers or buy a round)
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Yes No Contact fellow alumni
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If you want to contact fellow alumni, please list the class year or range, program or affinity group.
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Yes No Assist in promoting the event
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Yes No Assist in planning the event
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Yes No Other support
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If Other, describe the support you need
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* Will Kirkwood Alumni & Friends receive recognition for support?
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If you answered yes, please provide details. (e.g. Display a banner at the event, name in program, logo on screen, etc.)
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* Are you, your company, or organization willing to make a donation in support of Kirkwood students?
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Please provide the name(s) of any Kirkwood alumni, staff, or faculty involved with this event in addition to, or if different from, the requester above.
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Kirkwood Alumni & Friends reserves the right to refuse support of any event for any reason at any time. By submitting a request, you warrant that the information submitted is accurate to the best of your knowledge.
It is the policy of Kirkwood Community College not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental or marital status. If you have questions or complaints related to compliance with this policy, please contact the Vice President, Human Resources and Institutional Effectiveness, 6301 Kirkwood Blvd. SW, Cedar Rapids, IA 52404, 319-398-5572, equity@kirkwood.edu, or the Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: 312-730-1560 Facsimile: 312-730-1576, TDD 800-877-8339 Email: OCR.Chicago@ed.gov.
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