Requestor's Name

Email

Phone

Teacher's / Alumni Name

(Include maiden name if applicable)

Teacher's / Alumni Email

Teacher's / Alumni Phone

School Name

Subject Matter

Deadline

Address to ship kit

(If you are within a 60 mile radius from the main NEIU campus, please contact us for pick up details).

Other notes

Also send us a picture of you and your class with the NEIU gear - we would love to highlight these on our website. Thank you!

5500 North St. Louis Ave. | Chicago, Illinois 60625 | www.neiu.edu | Alumni@neiu.edu

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