NORTHERN ARIZONA UNIVERSITY

ALUMNI ASSOCIATION

Alumni Board of Directors – Application Questionnaire

Please fill out the form below as completely as possible.

If you would like attach your résumé.

PLEASE SUBMIT APPLICATION by March 31, 2015

Personal
Last Name / First Name / Middle Name
Prefix (Mr., Mrs., Ms., Dr., etc.) / Suffix (Jr., III, etc.) / Gender
¨ M ¨ F
Nickname(s) / Former Name(s)
Address/Phone
Street/PO Box / Apt/Unit
City / State / Zip
Home E-Mail / Home Phone / Home Fax
Employment
Current Employer or Employer Retired From (include year of retirement) / Your Title
Street/PO Box / Suite#
City / State / Zip
Business E-Mail / Business Phone / Business Fax
Type of Business / NAU Employee? (check all that apply)
¨ Faculty ¨ Staff ¨ Administration

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EDUCATION
Institution / Degree / Year Received / Major / If NAU, which campus?
CURRENT VOLUNTEER AFFILIATIONS
(Boards, Clubs, Community/Service/Professional Organizations – include offices held)
Name / Offices Held, if applicable
ACTIVITIES WHEN AT NAU, If Any
(Clubs/Organization, Athletics, Fraternities/Sororities, Resident Halls, Honors, NAU Scholarships)
Name / Start Year (if applicable) / Stop Year (if applicable)
REFERENCES
(Please list three references)
(1) Name / Title (if applicable)
Address (Street, City, State, Zip)
Daytime Phone / E-Mail (if applicable)

è è è

REFERENCES – (con’t)
(Please list three references)
(2) Name / Title (if applicable)
Address (Street, City, State, Zip)
Daytime Phone / E-Mail (if applicable)
(3) Name / Title (if applicable)
Address (Street, City, State, Zip)
Daytime Phone / E-Mail (if applicable)

Please give a brief statement on why you would like to serve on the NAU Alumni Board:

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What unique qualities, assets, skills, resources, etc. do you have, and how might you contribute to the success of the Alumni Board?

Are there any groups or constituencies of alumni that you believe you could serve particularly well?

I understand that attendance and participation at all quarterly Alumni Board meetings are required for active membership. Furthermore, I understand that travel and overnight accommodations for board meetings are at my expense. I also recognize my responsibility as an active board member to financially contribute annually at a level comfortable to me during my service on the Alumni Board.

¨ YES ¨ NO

Please return completed application electronically to:

or return via U.S. Mail to:

Georgette E. Vigil

Director – Office of Alumni Relations and Community Outreach

Northern Arizona University

PO Box 6034

Flagstaff, AZ 86011-6034

Office: 928-523-3937

Thank You!

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