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 * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Time of Death (If known) Hour hour123456789101112 : Minute minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Cause of Death (If known) Class Year Major Degree Collegiate Memberships Current Employee Job Title Date of Employment at MVSU (if applicable) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Years Employed with MVSU Date Retired/Separated from MVSU Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 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 * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Memorial/Funeral Time * Hour hour123456789101112 : Minute minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Location of Services * Death Resolution Needed By * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Death Resolution to be Read at Funeral * No Yes Requested by * Relation * Contact Phone Number * Please upload short biography of the deceased * Leave this field blank
