Full name of individual who passed
*
First Name
Last Name
Date of passing
*
-
Month
-
Day
Year
Date
Date of funeral or memorial service (if known)
-
Month
-
Day
Year
Date
Link to obituary (if available)
Connection to Dalhousie
*
Current student
Current faculty or staff member
Board of Governors member
Professor Emeritus
Honorary degree recipient
Other
Name of form submitter
*
First Name
Last Name
Submitter's email
*
example@example.com
Submitter's phone number
*
-
Area Code
Phone Number
Please verify that you are human
*
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