NORTHERN ARIZONA UNIVERSITY

ALUMNI ASSOCIATION
Alumni Board of Directors Nominee Questionnaire

Please fill out the form below as completely as possible.

Please respond using only the space provided. Please
do not attach additional pages to this application, e.g.,
resumes, letters of reference, etc.

PLEASE SUBMIT APPLICATION BY JANUARY 31, 2010

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)

  

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 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 of
Directors.

  

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What unique qualities, assets, skills, resources, etc. do you have, and how might they
contribute to 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 board meetings is a requisite for
active NAUAA Board membership. Furthermore, I understand that travel and overnight
accommodations for NAUAA Board meetings are at my expense. I also recognize my
responsibility as an active board member to financially contribute at a level comfortable to me
in the annual fund during each three-year term of my service on the NAUAA Board.

 YES  NO
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