nyslogo
 
 

UPDATE YOUR INFO

Hi! Thanks so much for taking the time to update your information. WE NEED YOU for Wave 4, and by sending this form in, you ensure that we'll have the easiest time reaching you when we start Wave 4 in 2013. With this in mind, please give us the most up-to-date information, and particularly any contact info that will stay the same through 2013 - we want to make sure we get in touch with you then. Thanks again!

Your Info

In this column, please enter information as it pertains to you. You'll use the next column to enter information for someone else. Please make sure to enter your email information as this is the most important contact information for Wave 4 in 2013.

Name Info

  • First Name

  • Middle Initial

  • Last Name

  • Nickname

  • Former Name
  • If you've gotten married since the last time you got in touch with us, please list your maiden name here. If you've changed your name, please let us know what your previous name was, so we can keep our records continuous. Thanks!




Email Info

  • Email Address 1
  • Please give us an email address that will be the same from now until June 2013. Thanks!


  • Email Address 2
  • Ditto for this one.



Current Address Info

  • Address Line 1:

  • Address Line 2:

  • City:

  • State:

  • Zip Code: -


Phone Info

  • Your Cell Phone ( ) - ext.


  • Another Number for you ( ) - ext.

  • What kind of number is it?
  • Is this the number for your house, office, work cell, etc

uncwhitenyswhitendlogo

©2011 National Youth Study. All rights reserved Smith et. al. The National Youth Study is a research project based at the University of Notre Dame and the University of North Carolina at Chapel Hill.