Fillable Alumni Nominations Form (California State University Channel Islands)

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Alumni Nominations Form (California State University Channel Islands)

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ALUMNI & FRIENDS ASSOCIATION
Catch the Wave
Alumni & Friends Association Board of Directors
Nomination Form (Alumni)
Nominees may self-nominate or be nominated by a third party. Nominators: please be sure that
you have complete information for your Nominee and inform the Nominee of your nomination.
The Nominating Committee will not be researching additional information on the Nominee so
complete information is crucial.
Name _________________________________________________________________
Graduation Year __________Degree____________Major________________________
Address _______________________________________________________________
City ___________________________________ State _________ Zip Code _________
Home Telephone Number _________________________________________________
E-mail_________________________________________________________________
Title __________________________________________________________________
Employer ______________________________________________________________
Business Address _______________________________________________________
City ___________________________________ State _________ Zip Code _________
Business Telephone __________________________ Fax _______________________
Name of Nominator (if not self-nominating): _____________________________
Email:
____________Best Phone Number: _____ _____
Name of Reference #1 _____
Email:
______Best Phone Number: ___________
Name of Reference #2 ___________
Email:
Best Phone Number: ___________
Clear All Form Fields
Brief Description of Work History and Current Career:
Degrees from Other Institutions:
Collegiate Activities While at CSUCI:
Alumni Activities:
Describe why you would like to serve as a member of the Alumni Association Board of
Directors.
Do you believe that you will be able to faithfully carry out the role and responsibility of a
CSUCI Alumni Association Board member as described on the attached?
Please complete this form and return it to:
Attn: Alumni Relations
California State University Channel Islands
One University Drive
Camarillo, CA 93012
or fax to (805) 437-2716
or email to
alumni.friends@csuci.edu
All completed forms must be to Alumni Relations no later than January 31, 2007.
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Alumni Nominations Form (California State University Channel Islands)

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Completed 22 July 2020

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