Name of Deceased Affiliation of Deceased (Check All that apply) Current MVSU Faculty/Staff Former MVSU Faculty/Staff Student Alumna/Alumnus Friend of the University Family of Employee/Trustee Sex Male Female Date of Death Time of Death (If known) Cause of Death (If known) Class Year Major Degree Collegiate Memberships Current Employee Job Title Date of Employment at MVSU (if applicable) Years Employed with MVSU Date Retired/Separated from MVSU MVSU Department MVSU Job Title Name of Surviving Spouse, Next of Kin, or Close Personal Friend Address of Surviving Spouse, Next of Kin, or Close Personal Friend List Civic Involvement Memorial/Funeral Date Memorial/Funeral Time Location of Services Death Resolution Needed By Death Resolution to be Read at Funeral No Yes Requested by Relation Contact Phone Number Please upload short biography of the deceased One file only.2 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav.
