| ABOUT YOU |
| Salutation |
Mr. Mrs. Ms. Dr.
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| First Name* |
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| Last Name* |
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| Relationship to deceased |
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| Class Year |
(if applicable)
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| Email* |
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| Phone* |
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ABOUT THE DECEASED
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| Name and contact information of an immediate survivor (if other than you) |
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| Name of deceased* |
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| Stanford class year(s) of deceased |
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| Date of death* |
(mm/dd/yyyy)
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| Age* |
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| City and state of residence*
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| Cause of death |
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Survivors (including name, relationship and, if applicable, Stanford class year(s) of spouse/partner, children, grandchildren, great-grandchildren, siblings and parents)
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| Previously deceased spouse and/or children (include name, relationship, and year of death) |
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| Student activities at Stanford |
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| Brief summary of career and personal history |
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| Other (including links to newspaper obituaries or text from memorial service programs) |
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