<h2 align="center"><img height="128" border="0" width="475" alt="" src="/id0904f67a805e90db" /></h2>
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<h2 align="center">Your Voice</h2>
<br /> The SIUE Alumni Association is committed to being the voice for alumni within the university. The Your Voice section gives you the chance to ask questions, share suggestions, register complaints or deliver compliments to the various departments and employees within the university. Please complete the form below and select the level of follow-up you would like to receive from our office. If you have any problems with the form, please send an e-mail to <a href="mailto:sjankow@siue.edu">sjankow@siue.edu</a>.
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<input name="subject" type="hidden" value="Email from SIUE Alumni Your Voice" /><input name="redirect" type="hidden" value="http://www.siue.edu/alumni/voicethankyou.shtml" /><input name="recipient" type="hidden" value="kabenne@siue.edu" /><br /><br />
<table border="0" width="514" align="center">
<tbody>
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<td class="head2a" colspan="2">
<h3 align="center">Your Voice Communication Form</h3>
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<td class="textbodybold" colspan="2" align="left"><strong>1. Alumni Communication</strong></td>
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<td width="155" class="text1" align="left">Are you sending a:</td>
<td width="344" align="left"><strong><select name="selectQuestion" id="selectQuestion"><option selected="selected">Choose One...</option> <option>question</option> <option>suggestion</option> <option>complaint</option> <option>compliment</option> </select></strong></td>
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<td class="text1" align="left">SIUE Department/Office (if applicable):</td>
<td align="left"><input name="SIUE Department/Office (if applicable):" maxlength="30" size="30" /></td>
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<td class="text1" align="left">SIUE Employee/Staff Member (if applicable):</td>
<td align="left"><input name="SIUE Employee/Staff Member (if applicable)" maxlength="30" size="30" /></td>
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<tr>
<td class="text1" colspan="2" align="left">Please enter your question, suggestion, complaint or compliment in the box below:<br /></td>
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<td class="textbody" colspan="2" align="center"><textarea name="Please enter your question, suggestion, complaint or compliment in the box below:" rows="8" cols="50" id="communication"></textarea></td>
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<td class="textbodybold"><strong>2. Your Information (Optional)</strong></td>
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<td width="155" class="text1" align="right">Last Name</td>
<td width="344"><input name="Last Name" maxlength="30" size="30" /></td>
</tr>
<tr>
<td class="text1" align="right">First Name</td>
<td><input name="realname" maxlength="30" size="30" /></td>
</tr>
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<td class="text1" align="right">Maiden Name</td>
<td><input name="Maiden Name" maxlength="30" size="30" /></td>
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<tr>
<td class="text1" align="right">Title Select title<br /></td>
<td class="text1"><input name="Title" type="radio" value="Mr." />Mr. <input name="Title" type="radio" value="Mrs." /> Mrs. <input name="Title" type="radio" value="Ms." /> Ms. <input name="Title" type="radio" value="Miss." /> Miss. <input name="Title" type="radio" value="Dr." /> Dr.</td>
</tr>
<tr>
<td class="text1" align="right">SIUE Graduation Year<br /></td>
<td><input name="Graduation Year" maxlength="30" size="30" /></td>
</tr>
<tr>
<td class="text1" align="right">E-mail</td>
<td><input name="email" maxlength="30" size="30" /></td>
</tr>
<tr>
<td class="text1" align="right">Current Mailing Address</td>
<td><input name="Current Mailing Address" maxlength="30" size="30" /></td>
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<td class="text1" align="right">City</td>
<td><input name="City" maxlength="30" size="30" /></td>
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<td class="text1" align="right">State</td>
<td><input name="State" maxlength="30" size="30" /></td>
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<td class="text1" align="right">Zip Code</td>
<td><input name="Zip Code" maxlength="30" size="30" /></td>
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<td class="textbody" colspan="2">Please provide any additional information that our office can utilize to better serve your needs:<br /></td>
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<td class="textbody" colspan="2" align="center"><textarea name="Please provide any additional information that our office can utilize to better serve your needs:" rows="8" cols="50" id="additional"></textarea></td>
</tr>
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<td height="50" class="text1" colspan="2"><input type="submit" value="Submit" /></td>
<td width="1"><br /></td>
</tr>
</tbody>
</table>
</form>
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