Alumni Association Board of Directors Candidate Form

Please complete this form to provide your information to the Nominating Committee to be considered for a director position.

First Name

Last Name

Maiden Name

Graduation Year

Address

City

State

Zip Code

County

Home Phone

Cell Phone

Preferred Email address

Employer

Job Title

Type of Industry

Family

Spouse

First Name

Last Name

Maiden

Graduation Date

Please list family members/relatives (include relationship and graduation year, if known) who have attended/are attending Shippensburg University.

Education

Shippensburg major and Graduation Year:

Advanced Degrees Earned (include degree and institution)

Professional Information

Professional awards or achievements - indicate award and year

Community Service (past and present)

Service to Shippensburg University (past and present)

What qualifications would you bring to the Alumni Board of Directors?

Goal Statement

Please provide a statement(s) reflecting your reason or interests in becoming a member of the Alumni Board.

I have completed the requested information for consideration by the Nominating Committee and I have read and agree to serve, if selected, in accordance with the “Position Description” for members of the Alumni Board of Directors.

Signature (or type if sending electronically)

Date:

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